Curriculum

2022

Fellowship of the
Australasian College for Emergency Medicine

V4.6 August 2023

1. Document Review

Timeframe for review: Every two years, or earlier if required

Document authorisation: Council of Education
Document implementation: Department of Education and Training
Document maintenance: Department of Education and Training

2. Revision History

Version Date Pages revised / Brief Explanation of Revision

3.1 January 2021 3rd Edition published
Page 9; addition made to Specific Training Requirements. Page 12; Addition of Urgent
3.2 August 2021 Care and accredited sites. Page 15; table restructure and detail added. Page 17; WBA
details added
4 December 2021 Updates to numbering and formatting
Page 17: Details of the Paediatric Emergency Requirement (PER) added
4.1 August 2022
Page 153: Professionalism – update to 1.4
4.2 November 2022 Page 58: Minor corrections
Page 129: Minor corrections
4.3 January 2023
Page 144: Minor corrections
Page 18-19: Minor corrections
4.4 March 2023
Page 152: Minor corrections
Page 10, 15 & 17: Training progression updates
4.5 May 2023 Page 16: WBA definition updates
Page 44 & 144: Terminology updates
4.6 August 2023 Page 109-112: Minor corrections

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 Contents
1. Introduction 6

1.1 Context ............................................................................................................................................................................ 6

1.2 Graduate outcomes...................................................................................................................................................... 6
1.3 Entrustable areas of practice.................................................................................................................................... 9

2. The FACEM Training Program 10

2.1 The Training Program structure.............................................................................................................................. 10

2.2 Training outside the emergency department .....................................................................................................11
2.3 Teaching and learning strategies........................................................................................................................... 13

3. Assessment of knowledge, skills and attributes 15

3.1 Assessment methodologies..................................................................................................................................... 16

3.2 Teaching and learning strategies and assessments key.................................................................................20

4. Knowledge, skills and attributes for Emergency Medicine 21

Medical Expertise..................................................................................................................................................................... 21

1. Foundations of Emergency Medicine .........................................................................................................................................22

1.1 Anatomy......................................................................................................................................................................................22
1.2 Physiology..................................................................................................................................................................................27
1.3 Pathology....................................................................................................................................................................................31
1.4 Pharmacology......................................................................................................................................................................... 35
2. Principles of Practice in Emergency Medicine....................................................................................................................... 39

2.1 Prehospital Care..................................................................................................................................................................... 39

2.2 Initial Emergency Medicine Care.....................................................................................................................................41
2.3 Resuscitation Medicine....................................................................................................................................................... 42
2.4 Focused Assessment..............................................................................................................................................................47
2.5 Analysis of Investigations.................................................................................................................................................. 53
2.6 Ultrasound in the emergency department................................................................................................................ 58
2.7 Treatment..................................................................................................................................................................................60
2.8 Observational Medicine.......................................................................................................................................................61
2.9 Documentation and Handover........................................................................................................................................ 62
2.10 Patient Disposition .............................................................................................................................................................. 63
3. Clinical Management in Emergency Medicine....................................................................................................................... 64

3.1 Cardiovascular Presentations.......................................................................................................................................... 64

3.2 Respiratory Presentations................................................................................................................................................. 66
3.3 Gastrointestinal Presentations.........................................................................................................................................67
3.4 Neurological Presentations.............................................................................................................................................. 69
3.5 Ophthalmological Presentations.................................................................................................................................... 71
3.6 Otolaryngologic Presentations........................................................................................................................................72

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 Medical Expertise continued

3.7 Acute Psychiatric and Addiction Related Presentations .....................................................................................74

3.8 Toxicological and Environmental Emergency Presentations.............................................................................76
3.9 Endocrinological Presentations.......................................................................................................................................79
3.10 Haematological Presentations........................................................................................................................................80
3.11 Oncological Presentations.................................................................................................................................................81
3.12 Renal and Urogenital Presentations............................................................................................................................ 82
3.13 Rheumatological Presentations.....................................................................................................................................84
3.14 Dermatological Presentations......................................................................................................................................... 85
3.15 Infectious Disorders..............................................................................................................................................................86
3.16 Immunological Presentations.........................................................................................................................................88
3.17 Obstetric and Gynaecological Presentations........................................................................................................... 89
3.18 Metabolic Presentations......................................................................................................................................................91
3.19 Orthopaedic Presentations............................................................................................................................................... 92
3.20 Trauma........................................................................................................................................................................................ 95
3.21 Paediatric Presentations..................................................................................................................................................100
3.22 Geriatric Emergency Medicine....................................................................................................................................... 105
3.23 Procedures in Emergency Medicine............................................................................................................................108
Prioritisation and Decision Making....................................................................................................................................113

1. Prioritisation of Patient Management.......................................................................................................................................113

2. Clinical Risk............................................................................................................................................................................................114

3. Decision making...................................................................................................................................................................................116
Communication....................................................................................................................................................................... 118

1. Principles of Effective Communication.....................................................................................................................................118

2. Communication with Colleagues................................................................................................................................................ 120

3. Intercultural Communication........................................................................................................................................................122

4. Communication with Patients and Carers .............................................................................................................................123

Teamwork & Collaboration.................................................................................................................................................. 124
Leadership & Management..................................................................................................................................................127

1. Roles and responsibilities in the emergency department.............................................................................................127

2. Human Resource Management................................................................................................................................................... 128

3. Operational Management of the ED and the Floor........................................................................................................... 129

4. Leadership in the emergency department.............................................................................................................................131

5. Mass Casualty Incidents and Disaster Management.........................................................................................................132

6. Patient Safety and Quality Management.................................................................................................................................133

7. Complaints..............................................................................................................................................................................................135
Health Advocacy..................................................................................................................................................................... 136

1. Principles of Health Advocacy..................................................................................................................................................... 136

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 Health Advocacy continued

2. Cultural awareness, competence and safety........................................................................................................................ 138

3. Advocacy for Vulnerable Patients.............................................................................................................................................. 140

4. Indigenous health...............................................................................................................................................................................141

5. Refugee health.................................................................................................................................................................................... 143

6. End of Life Care................................................................................................................................................................................... 144

Scholarship & Teaching........................................................................................................................................................146

1. Critically Appraising and Applying the Evidence................................................................................................................. 146

2. Research Methodology.................................................................................................................................................................... 148

3. Learning in Emergency Medicine .............................................................................................................................................. 150

4. Teaching in Emergency Medicine................................................................................................................................................152

Professionalism...................................................................................................................................................................... 153

1. Professional Conduct and its Regulation................................................................................................................................153

2. Ethics and Medicolegal Frameworks in Emergency Medicine...................................................................................... 154

3. Responsibility to Profession and Self.......................................................................................................................................157

5. Rural & Regional Emergency Medicine Practice 159

6. Recommended resources 162

6.1 Foundations of Emergency Medicine.................................................................................................................. 162

6.2 Clinical Management in Emergency Medicine.................................................................................................. 162
6.3 Additional Clinical Texts.......................................................................................................................................... 162
6.4 Journals........................................................................................................................................................................ 163
6.5 ACEM Educational Resources................................................................................................................................. 163
6.6 ACEM-endorsed Standards, Statements and Guidelines.............................................................................. 163

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1. Introduction

1.1 Context
The Australasian College for Emergency Medicine (ACEM) is committed to the promotion of excellence in
the provision of quality emergency care to all communities across Australia and Aotearoa New Zealand. This
commitment acknowledges that medical practitioners who provide emergency care require a range of clinical,
academic, personal and professional attributes and expertise to deliver these services with confidence and at a
consistently high standard. As such, the FACEM Curriculum seeks to describe the essential knowledge, skills and
attributes expected of Emergency Medicine Physicians who are equipped to practise effectively in a culturally
diverse and continuously evolving healthcare environment.

The original ACEM Curriculum Framework underwent a significant redesign as part of the Curriculum Review
Project (CRP) from 2011 to 2014. This edition of the FACEM Curriculum is the result of an extensive three-year
curriculum review process, commencing in 2017. Informed by the views of trainees and Fellows gleaned since
the curriculum’s inception, the ACEM Council of Education conducted multiple periods of formal consultation
over a two-year timeframe, with internal and external stakeholders informing the review. Special Interest Groups
across the emergency medicine and critical care disciplines, health jurisdictions, hospitals providing emergency
medicine training, consumer advocate groups, and other specialist medical colleges were all invited to contribute
to the review. Public health data, reports from government agencies, clinical practice guidelines, and emergency
medicine and critical care curricula from across the world were also analysed and considered as part of the review,
to ensure that the final document accurately reflects the requisite knowledge, skills and attributes expected of a
specialist Emergency Medicine Physician. Furthermore, the medical education literature was reviewed to ensure
that the assessment tools and modes of delivery of the curriculum and associated training program are fit for
purpose, robust, contemporary and aligned to best practice in medical education. Indeed, ACEM has committed to
the ongoing review and evaluation of the FACEM Curriculum to ensure the it remains a fluid and dynamic document
that is responsive to the needs of Emergency Medicine Physicians, patients of emergency departments and the
broader communities of Australia and Aotearoa New Zealand.

1.2 Graduate outcomes

The FACEM Curriculum follows the CanMEDS model for specialist physician curricula that has, since its inception,
been adopted by specialist medical colleges around the world. The eight domains of the framework define the
outcomes for each stage of training, including the final graduate outcomes, for all areas of practice as a specialist
Emergency Medicine Physician in Australia and Aotearoa New Zealand and provide a comprehensive foundation
for lifelong learning in this speciality.

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| Introduction |

Table 1. Outcomes of the FACEM Curriculum

Domain Training Stage 1 Training Stage 2 Training Stage 3 Graduate Outcomes

Independently assess and manage
Independently assess and manage
patients with single system Independently assess and manage
patients with high complexity Deliver safe and effective care to
problems and medium complexity all medium complexity patients.
presentations. all presentations and through all
Medical Expertise patients not requiring resuscitation. Resuscitate and manage critically ill
Resuscitate and manage critically ill stages of the patient’s journey in
Recognise unstable and or injured patients who respond to
or injured patients unresponsive to the emergency department.
deteriorating patients and initiate first-line therapy.
first-line therapy.
resuscitation in these.
Seek assistance, when appropriate, to
Utilise strategies to prioritise tasks
Independently make and prioritise make and prioritise timely decisions
and optimise decision making
Independently prioritise decisions, timely decision regarding the care regarding the care of multiple
to deliver the highest quality
tasks, and referrals for a single of multiple patients with single patients with complex or multi-
patient care, often with limited
patient, seeking assistance when system problems. Recognise system problems. Accommodate
Prioritisation & Decision Making available information. Demonstrate
prioritising for several patients. factors that impinge on safe and factors that impact on performance.
continued situational awareness
Implement strategies that influence effective decision making. Practise Practise heightened situational
with increased task loading within
decision making. situational awareness and adapt awareness relating to both
the ED and as well as the hospital
work practices accordingly. department and patient management
environment.
and respond accordingly.
Rapidly and effectively establish Maintain effective professional and
Establish optimal rapport, and
rapport and trust, adapting patient-centred communication in
Communicate clearly and accurately communicate effectively in complex
communication skills to meet the a complex environment. Utilise a
with patients and colleagues circumstances, with speed and
needs of different people and broad communication skill repertoire
Communication in uncomplicated situations. accuracy, with patients of all ages
circumstances. Recognise and to resolve difficult situations and to
Demonstrate accurate and concise and cultures, families/whānau and
seek further advice in difficult deliver bad news in most situations
written communication skills. caregivers, and colleagues of all
communication situations, including whilst recognising when to involve
disciplines.
delivery of bad news. others.
Participate as an effective team Undertake an increasing number Confidently adapt to any team
member to treat all emergency of appropriately designated roles, member role as directed to treat
patients. Co-ordinate an initial acting as a team leader in simple any emergency patient. Function
Effectively manage and participate
resuscitation team until a senior clinical scenarios, and under as an effective team leader in most
in an interprofessional team,
Teamwork & Collaboration clinician’s arrival. Collaborate clinical scenarios, and collaborate
supervision in complex clinical particularly at times of high stress
with patients, families/whānau with patients, families/whānau
scenarios. Collaborate across and medical emergency.
and caregivers, and other health and caregivers, and other health
professionals to enact patient interprofessional teams to provide professionals on issues beyond the
management plans. effective patient care. immediate clinical scenario.

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| Introduction |
Table 1 continued. Outcomes of the FACEM Curriculum

Domain Training Stage 1 Training Stage 2 Training Stage 3 Graduate Outcomes

Act as a positive role model to Effectively multitask to manage Comfortably manage an Emergency Provide clinical supervision,
junior staff, obtain assistance as individual workload, manage a Department with remote senior management and leadership and
required when managing workload, department when they are the most support, clearly identify when and actively foster a culture of patient
and contribute to operations of the senior clinical on duty, recognise how to activate support systems, safety. Participate in quality
Leadership & Management
department with support of senior when to devolve responsibility to a and supervise the clinical work of all improvement activities to create
staff, including participation in senior clinician, and engage in the junior clinicians. Understand the role a departmental administrative
departmental quality improvement supervision of competent junior of the Emergency Department within framework to support safe clinical
activities. clinicians. the hospital system. practice.
Advocate for the best immediate Systematically screen and intervene
Regularly screen for factors
outcome for patients in relation to protect and advance health and
that affect health outcomes in
to accessing available health well-being of all patients within the
emergency patients, utilise local Protect and advance the health and
resources. Demonstrate awareness Emergency Department, integrating
Health Advocacy available resources and intervene to wellbeing of any individual patients,
of medical, social, and cultural the factors which affect patients
improve health outcomes. Advocate communities and populations.
factors that may impact on patient beyond the Emergency Department,
for a patient’s best interests from
encounters in the Emergency and proactively engage in health
presentation to discharge.
Department. promotion.
Take responsibility for self-directed
learning, informed by reflective
Undertake learning focused on
practice and role model influences. Proactively identify own learning
attaining mastery at the level of a
Participate in departmental needs and respond appropriately. Make sound judgements regarding
FACEM graduate. Use evidence-based
teaching to further knowledge and Apply established evidence- the creation, translation, application
practice as the foundation for clinical
skills. Retrieve clinical references based practice to patient care and and dissemination of medical
care and systematically evaluate
to guide self-education and patient appreciate own responsibility to knowledge. Commit to independent
Scholarship & Teaching its relevance. Create and address
care. Actively teach junior staff contribute to clinical research. advancement and maintenance
meaningful research questions,
skills expected of a novice clinician. Teach colleagues and patients in of own professional skills and
routinely seize the teachable moment,
Participate as the facilitator/ clinical and other environments. knowledge, as well as contributing
and demonstrate understanding that
instructor in departmental Provide effective role modelling to to the teaching of others.
providing education is integral to
educational activities. junior staff.
emergency medicine practice.
Demonstrate the ability to source
and apply evidence.
Independently reflect on professional
Maintain high standards in Engage in increasingly independent
ethics and behaviour for ongoing Practice ethically and adhere to
behaviour and ethical practice. reflective practice, focusing on self-
self-development. Routinely adapt medicolegal requirements, adopt
Appreciate mechanisms to protect improvement in professional ethics
professional behaviour in times and role model sound wellbeing
Professionalism self from detrimental effects of and behaviour. Utilise strategies
of clinical complexity and in the practices, and actively commit to
work-related stress and comply with to enable continued professional
challenging Emergency Department and promote the maintenance of
professional responsibilities and behaviour in challenging
environment. Utilise strategies to professional standards.
obligations. circumstances.
maintain a healthy work-life balance.

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| Introduction |

1.3 Entrustable areas of practice

Integration of the graduate outcomes detailed in the domains of the FACEM Curriculum, assessed programmatically
throughout the FACEM Training Program, culminates in three entrustable areas of practice in emergency medicine:

1. High quality patient care – The FACEM provides optimal care for any single patient through the
application of knowledge and skills across the domains of Medical Expertise, Prioritisation and
Decision Making, Health Advocacy, Communication, and Professionalism. This entrustable area of
practice is assessed throughout the FACEM Training Program in Workplace-based Assessments, In-
Training Assessments, the Paediatric Emergency Requirement and Examinations
2. Professional workplace performance – The FACEM performs at their best in the dynamic and demanding
environment that is the emergency department by integrating knowledge and skills in the domains of
Communication, Teamwork and Collaboration, Leadership and Management, and Professionalism. This
area of entrustable practice is assessed during training in Shift Reports and In-Training Assessments.
3. Commitment to career longevity – The FACEM possesses skills and values that sustains them throughout
their career utilising skills in the domains of Scholarship and Teaching, and Professionalism. This
entrustable area of practice is assessed during the FACEM Training Program in In-Training Assessments
and the Research Requirement.

Figure 1. FACEM Training Program Entrustable Areas of Practice

High-quality patient care Professional workplace

• Medical expertise
performance
• Prioritisation and • Communication
decision-making • Teamwork and collaboration
• Health advocacy • Leadership and management
• Communication • Professionalism
• Professionalism

Commitment to career
longevity
• Scholarship and teaching
• Professionalism

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2. The FACEM Training Program

2.1 The Training Program structure

Table 2. FACEM Training Program Structure for trainees commencing training after 1 February 2022

Training Stage 1 (TS1) Training Stage 2 (TS2) Training Stage 3 (TS3) Training Stage 4 (TS4)

6 Months FTE in ED*

12 Months FTE and
12 Months FTE in ED 12 Months FTE in ED
(Adult or Mixed) ED
6 Months FTE Elective (ED
or Non-ED) * #
Placement
Including min 6 months FTE in a Major Referral ED
requirements
and 12 months FTE in a Non-Major Referral ED
and 6 Months FTE in Non-ED at any time during TS1-TS3#
and 6 Months FTE in Critical Care (adult or mixed ICU and/or Anaesthetics) at any
time during TS2-TS4#
Limited to time
Maximum time
3 years 8 years remaining of 12 year
per stage
overall time limit
Maximum total 12 years
ITAs
(every 3 calendar months)
EM-WBAs (in TS1 ED) EM-WBAs (in TS2 ED) EM-WBAs (in TS3 ED) EM-WBAs (in TS4 ED)

• 8 x Mini-CEX (must • 4 x CbD (must • 4 x CbD (must include In ED:

include one of each include 2 x medium 3 x high complexity)
Programmatic Neurological, complexity) • 3 x Shift In-charge
assessment
• 3 x Mini-CEX Report
Respiratory,
requirements
• 4 x Mini-CEX (must (including 2 x high
Cardiovascular and • 2 x Team Lead
include 2 x medium complexity)
Abdominal) Resuscitation
complexity)
• 3 x Shift Reports
• 1 x Comm Skills
• 1 x Comm Skills
(Handover)
(Handover)
• 1 x Comm Skills
• 1 x Comm Skills
(Referral)
(Referral)
*All ED and Elective placements in TS4 must have received TS4 accreditation, including Non-ED

#To be taken in minimum 2 x 3-month FTE terms or 1 x 6-month FTE term

Training Stage 1 (TS1) Training Stage 2 (TS2) Training Stage 3 (TS3) Training Stage 4 (TS4)

M&M presentation
Formal Teaching Presentation
Guideline/Protocol Review or Clinical Audit
Procedural Requirement (Core DOPS)
Training
requirements To be completed to be eligible for the Fellowship Clinical Examination:
Paediatric Emergency Requirement (PER) (additional 6 x PER-WBAs, 2 x PER-DOPS, Portfolio
- a maximum of 2 PER DOPS and 1 PER Mini-CEX may be completed in Training Stage 1)
Research Requirement
Primary Written and
Examinations Fellowship Written Fellowship Clinical
Primary Viva
To be completed to be eligible for the Fellowship
To be completed to be
Written Examination:
eligible for the Primary
Viva Examination: • Critical Care Airway Management

Online module • ACEM Core Values • Clinical Supervision

requirements • Indigenous Health & • Giving Feedback
Cultural Competence • Ultrasound
• Assessing Cultural To be completed to be eligible for the Fellowship Clinical Examination:
Competence
• Clinical Leadership

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| The FACEM Training Program |

2.2 Training outside the emergency department

Placements undertaken outside ACEM-accredited Emergency Departments are valuable components of the FACEM
Training Program for both trainees and for the development of the emergency medicine speciality itself. Emergency
medicine is the nexus through which other specialities interact regarding emergent and acute presentations.
Periods of focused immersive training undertaken outside the emergency department enhance the development
of knowledge and skills fundamental to the practice within it. Effective collaboration between Emergency Medicine
Physicians and specialists of other medical disciplines is crucial to the provision of patient-centred care and the
optimisation of processes and systems within hospitals.

Critical Care placements

Critical care placements may be undertaken in accredited Anaesthetics and/or Intensive Care Units accredited by
ANZCA, CICM or ACEM. Under the supervision of Critical Care consultants, trainees are able to refine skills developed
in the emergency department, including, but not limited to:

• Effective use of airway adjuncts and bag-valve-mask ventilation;

• Effective use of a range of invasive airway equipment for intubation;
• Initiation and management of invasive haemodynamic monitoring in an anaesthetised patient;
• Development of acute and ongoing pain management plans;
• Performance of procedural sedation, and local and regional anaesthesia;
• Insertion and management of arterial and venous cannulation.

Non-ED placements
Non-ED placements may be undertaken in sites accredited by other specialist medical Colleges, and in Special
Skills Placements (SSPs) and other contexts accredited by ACEM, for the purposes of FACEM training, as detailed in
Table 3.

Placements in in-patient wards of hospitals provide trainees the opportunity to develop appreciation of the
patient’s journey after the emergency department encounter, and the clinical knowledge and skills required to
manage patients in these contexts.

Learning experiences in ACEM-accredited SSPs vary and are based on learning outcomes detailed in the individual
SSP Accreditation Guidelines available on the ACEM website. These range from skills developed in teaching and
learning during a Medical Education placement, to the clinical and technical skills acquired during a Prehospital
and Retrieval Medicine placement. Additional opportunities for structured training also exist in Global Emergency
Care, which is considered and accredited on a case-by-case basis. Some SSPs provide a focus on senior clinical
leadership and management expertise, and so are accredited for trainees to undertake in the final stage of FACEM
training. Irrespective of the context in which they take place, ACEM-accredited non-ED training experiences are
directly related to and further enhance the knowledge and skills acquired and applied in the emergency department.

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| The FACEM Training Program |

Table 3. Non-ED training placements for trainees commencing training after 1 February 2022

Specialty Sites accredited by Certified as

Critical Care ANZCA Anaesthetics

CICM Intensive Care Medicine

Urgent Care RNZCUC Urgent Care

General Practice RACGP General Practice
ACRRM

General Medicine RACP Cardiology Paediatrics

Clinical Pharmacology Neurology
Gastroenterology Public Health Medicine
Infectious Disease others
Neonatology/Perinatology

Medical Administration RACMA Medical Administration

Pain Medicine ANZCA - Faculty of Pain Medicine Pain Medicine

Sports & Exercise Medicine ACSEP Sports & Exercise Medicine

Surgery RACS General Surgery (adult or paed.) Plastic and Reconstructive

Orthopaedic Surgery Surgery
Neurosurgery Cardiothoracic Surgery
Otolaryngology Head and Neck Urology
Surgery Vascular Surgery

Ophthalmology RANZCO Ophthalmology

Obstetrics & Gynaecology RANZCOG Obstetrics & Gynaecology

Pathology RCPA Pathology

Psychiatry RANZCP Psychiatry

Radiology RANZCR General Radiology

Special Skills Placement ACEM Clinical Informatics Medical Education/Simulation

Drug & Alcohol Addiction Ophthalmology & ENT
Management Emergency Medicine
Emergency Medicine Research Pre-Hospital and Retrieval
Forensic Medicine Medicine

Geriatric Emergency Medicine Rural/Remote Health

Hospital in the Home Toxicology/Addiction Medicine

Hyperbaric Medicine Trauma

Indigenous Health Ultrasound

Medical Administration/Safety Women’s Emergency Care

& Quality

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| The FACEM Training Program |

2.3 Teaching and learning strategies

The ACEM Council of Education is cognisant of the variety of trainees who may undertake the FACEM Training
Program and the range of expertise they will bring to their training experience. As with all medical practitioner
training programs, undergraduate and postgraduate, adult learning principles apply. Trainees, supported by those
responsible for training in accredited training sites, ascertain their learning needs to effectively plan and direct
their experiences that will support their growth and development as Emergency Medicine Physicians, during the
FACEM Training Program, and throughout their lifelong learning experience.

The FACEM Curriculum and associated Training Program facilitate the spiral and experiential nature of specialist
medical education. Learning outcomes in each domain are articulated for each stage of training, demonstrating
that topics and themes are regularly revisited with each patient presentation, as trainees move from site to site
throughout the program and as they progress from one Training Stage to the next. Each encounter brings new
knowledge and skills to be developed, more advanced application of such expertise, and an increase in proficiency
through appropriately supported structured education programs, self-directed learning and supervised practical
training experiences. Independent and supported reflective practice, along with contemporaneous, constructive
and specific feedback on performance from colleagues and supervisors, enables trainees to customise their training
experience to meet their specific learning requirements and prepare appropriately for formal assessments.

The FACEM Curriculum and associated Training Program rely on multimodal methods of teaching. The following
teaching and learning strategies specific to the FACEM Curriculum and Training Program include a range of delivery
modes and sources of reference so as to cater to the variety of learning styles and levels of expertise of all FACEM
trainees.

Education Support Resources

The ACEM Education Resources website provides trainees with readily accessible learning support resources,
including bespoke self-contained e-learning modules (eLM). These resources are mapped directly to the
learning outcomes articulated in the curriculum and can be accessed at the trainee’s own pace according to
their individual needs. The resources are designed to support trainees, educators, supervisors and Directors of
Emergency Medicine Training and serve as a useful point of reference for appraisal and assessment.

Structured Education Program (SEP)

Structured Education Programs are delivered in accredited training sites by Emergency Medicine Physicians, other
specialist consultants, senior FACEM trainees and where appropriate, other facilitators. The programs reflect
adult learning principles, consider different learning styles of trainees and are designed to align with the learning
outcomes detailed in the FACEM Curriculum and the needs of the trainees.

Programs must also include simulation-based education, particularly for clinical encounters that are
uncommon or are of high risk and require structured and specific teaching of vital skills in order to mitigate
against underlying causes of adverse events. Simulation-based training provides invaluable opportunities
for development and assessment of knowledge, technical and non-technical skills and critical prioritisation,
decision-making, teamwork and collaboration skills.

The SEP timetable should be distributed in a timely manner and include opportunities for trainees to deliver
education and/or facilitate preparation for assessments and examinations, as appropriate.

Supervised Training (ST)

The FACEM Training Program follows an apprenticeship model of learning, whereby trainees develop the requisite
knowledge and skills during everyday work in an accredited training site under the supervision of suitably skilled
consultants and other personnel. Training sites utilise models of care and rostering practices to ensure trainees
are supervised in the workplace appropriate to their level of training and the site’s patient case-mix. Given the
nature of emergency medicine practice, training sites must ensure that there is a rostered consultant for trainees
to access when direct clinical supervision is not possible.

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| The FACEM Training Program |

Self-directed Learning (SDL)

In line with adult learning principles, the FACEM Training Program requires trainees to undertake self-directed
learning to ensure their individual learning and development needs are met. Trainees take responsibility for
their own learning by determining their needs, setting goals, identifying resources, implementing a plan to
meet their goals, and evaluating the outcomes. SDL encompasses independent activities, including researching
online or in recommended texts and journals, and those activities that require communication with supervisors,
consultants, experts, and peers who guide and support trainees, helping them recognise their growth and areas
requiring further development.

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3. Assessment of knowledge, skills and attributes

The learning outcomes described in the FACEM Curriculum detail the knowledge, skills and attributes required of a
competent and effective Emergency Medicine Physician practising in Australia and Aotearoa New Zealand.

A curriculum must comprise an assessment regimen designed to assess achievement of the stipulated learning
outcomes. The FACEM Curriculum takes a combined approach to assessment, utilising both programmatic and
traditional assessment methodologies. A suite of assessment tools, including Workplace-based Assessments
(WBAs) and In-Training Assessments (ITAs), is utilised throughout training, the results of which are combined and
analysed by Trainee Progression Review Panels who make summative decisions on trainee progress from one
Training Stage to the next. When required, learning development plans are created and implemented, scaffolded
by a focus on regular and contemporaneous feedback on performance and competence development. Written and
Clinical Examinations, and assessments of satisfactory completion of specific training requirements, contribute
further to decisions on trainee progression and final assessment of competence.

Figure 2. Assessment program for the FACEM Curriculum.

Fellowship
Summative Primary Fellowship
Written
assessment Examination OSCE
Examination

Training Stage 1 Training Stage 2 Training Stage 3 Training Stage 4 FACEM

Programmatic WBAs WBAs WBAs WBAs

assessment ITAs ITAs ITAs ITAs

Training Research Requirement

requirements Procedural Requirement

Paediatric Emergency Requirement

Guideline/protocol review
or Clinical Audit,
M&M Presentation,
Formal teaching presentation

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| Assessment of knowledge, skills and attributes |

3.1 Assessment methodologies

The following assessment methodologies are implemented in the FACEM Curriculum.

Workplace-based Assessments (WBA)

The clinical encounters that trainees face every day provide rich learning experiences that are assessable.
The purpose of Workplace-based Assessments (WBAs) is to assess trainees, whenever possible, at the
time of doing, in real patient scenarios during normal daily work. When a trainee is involved in a clinical
encounter or performing a procedure that may be assessed, an Assessor utilises the relevant tool to assess
the trainee’s performance against the standards described for each criterion.

The suite of WBAs for the FACEM Training Program include:

Mini-Clinical Evaluation Exercise (mini-CEX) involves a trainee being directly observed by an Assessor
whilst performing a focused clinical task during a specific patient encounter, including history taking,
physical examination, clinical synthesis or patient consultation.

Case-based Discussion (CbD) is conducted between the trainee and the Assessor after the clinical
encounter has taken place. The Assessor rates and provides feedback on the trainee’s clinical reasoning
in the case, based on the patient’s case notes and discussion of the case with the trainee.

Communication Skills required for competent clinical handover and patient referral are assessed during
these tasks. For a clinical handover, the Assessor rates and provides feedback on the trainee’s capacity
to convey salient clinical information, specify incomplete assessment and management tasks, and
provide appropriate documentation in order to minimise the risk associated with handover. For referrals,
assessment is based on the trainee’s ability to accurately convey clinical findings, provisional diagnosis,
management plan and reason for the referral.

Shift Reports and Shift In-Charge Reports are based on the trainee’s performance throughout a normal
shift and when the trainee is in charge, respectively. Trainees are assessed in all domains of the
curriculum, with a particular emphasis on Leadership and Management for shifts in which the trainee is
in charge. Feedback may be provided during the shift, as required, or at the completion of the shift.

Team Lead Resuscitation assessments involve the direct observation of a trainee leading a team during
the resuscitation of a patient. The ability to lead a team during a resuscitation is essential for all FACEMs
and this assessment provides the opportunity for trainees to consolidate their leadership skills.

Morbidity and Mortality Meeting Presentations require trainees to prepare and present at a morbidity
and mortality (M&M) meeting, including providing a case summary, error analysis, and proposed future
actions, supported by contemporary best-practice literature.

Teaching Presentations require trainees to prepare and deliver a teaching presentation as part of the
structured education program at their training site. These may be case presentations with focussed
literature reviews, or the teaching of a procedural skill in simulation.

Guideline/Protocol Review or Clinical Audit requires trainees to select a clinical guideline or protocol
from their training site, undertake a review in light of current best-practice literature, and propose
potential amendments, if appropriate, to improve patient care. Similarly, clinical audit involves selecting
and measuring a clinical outcome or process against well-defined standards of evidence-based medicine
in order to identify changes required to maximise quality of care.

In-Training Assessments (ITA)

ITAs are conducted every three (3) calendar months throughout training by the Director of Emergency
Medicine Training (DEMT) or Supervisor. ITAs track the trainee’s progress against the learning outcomes for
a given Training Stage in each domain of the FACEM Curriculum. At the start of a Training Stage, trainees will
likely be ‘progressing towards standard’, demonstrate a steady rate of improvement in following ITAs, and
are expected to be at least ‘at standard’ for each domain by the completion of that Training Stage. The ITA
tool enables trainees to reflect on their own progress and facilitates the provision of constructive feedback
on progress and performance by the DEMT or Supervisor, discussion of which informs the development of
learning intentions for the following ITA period.

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Research Requirement (RR)

The Research Requirement, aligned to the Scholarship and Teaching domain of the FACEM Curriculum,
requires trainees to develop their skills in applying best evidence and academic knowledge to their practice
in emergency medicine. The Research Requirement may be undertaken by either coursework (University
studies) or original research (paper, project or thesis).

Procedural Requirement (PR)

The Procedural Requirement comprises core procedures that are assessed using the Direct Observation
of Procedural Skills (DOPS) WBA tool. These DOPS procedures, considered integral to the practice of
emergency medicine, involve a trainee being observed by an Assessor whilst performing a specific clinical
procedure. The Assessor rates and provides feedback on the trainee’s performance, from the technical
part of performing the procedure to post-procedure management and discharge advice, as applicable. The
Procedural Requirement will be noted by the relevant Trainee Progression Review Panel once all core DOPS
have been completed successfully and submitted in the online Trainee Portal.

Paediatric Emergency Requirement (PER)

The Paediatric Emergency Requirement requires trainees to integrate knowledge and skills across all
domains to the Paediatric Presentations section of the curriculum. The components of the Paediatric
Emergency Requirement are designed to facilitate learning and assessment, and to optimise exposure to an
appropriate breadth and acuity of paediatric emergency presentations.

Trainees will be advised to plan their training to ensure that they will have adequate access to paediatric
emergency cases. The components of the Paediatric Emergency Requirement must be completed in:

(i) Paediatric EDs accredited for Specialist Paediatric Emergency Medicine training, and/or

(ii) mixed EDs accredited by ACEM for the Paediatric Emergency Requirement (current ‘paediatric
logbook accredited’ sites, with a minimum of 5000 paediatric presentations annually).

The Paediatric Emergency Requirement comprises eight (8) WBAs (in addition to the WBAs required for each
Training Stage in table 2) and the completion of a Paediatric Emergency Portfolio (PEP). The PER may be
started in Training Stage 1 and can be completed at any time from Training Stage 2. It must be completed to
be eligible for the Fellowship Clinical Examination.

Paediatric Workplace-Based Assessments (WBAs)

Trainees must have completed the below specified paediatric WBAs to be eligible for the Fellowship Clinical
Examination. In Training Stage One, trainees may complete one PER Mini-CEX and two PER DOPS. The
remainder must be completed in later Training Stages.

3 x Mini-Clinical Examination (mini-CEX)

• Paediatric patient discharge communication for common diagnosis, e.g., asthma, bronchiolitis,
gastroenteritis (minimum of low complexity);
• Focussed assessment of a paediatric patient aged two (2) to twelve (12) years (verbal - communication
with child) with unclear diagnosis, e.g., shortness of breath, or abdominal pain (minimum of medium
complexity); and
• Focussed assessment of a paediatric patient aged less than two (2) years (non-verbal –
communication with carer), with unclear diagnosis, e.g., shortness of breath, or abdominal pain
(minimum of medium complexity).
3 x Case-based Discussions (CbD)

Including at least one each of:

• two (2) to twelve (12) years of age; and

• less than two (2) years of age.
Of the three (3) CbDs, at least one must be a case of medium complexity, and at least one case must be of
high complexity.

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2 x Direct Observation of Procedural Skills (DOPS)

• Specimen collection for lab analysis, for a paediatric patient of five (5) years or less of age for any of
the following: peripheral intravenous cannula insertion, suprapubic catheter aspiration, in-dwelling
urinary catheter aspiration, lumbar puncture; and

• Procedural sedation, for paediatric patient of five (5) years or less of age.

Paediatric Emergency Portfolio (PEP)

The portfolio is designed with variable training situations in mind (e.g., mixed vs Paediatric EDs). Rather
than a formal piece of assessment on which progression decisions are made, the PEP provides a mechanism
for recording training experiences, enabling:

— Trainees to monitor, reflect on, and direct their own learning and training appropriately;
— DEMTs to monitor and comment on the trainee’s experience and performance in each ITA, ensuring
it is appropriate for the relevant Training Stage;
— Facilitated discussion as part of the ITA feedback discussion; and
— ACEM to monitor the trainee’s experience and the exposure to paediatric cases provided by
training sites.

The PEP can be transferred between sites. It ensures a minimum, consistent experience for all, regardless
of the ED type and setting. Trainees will be required to record a minimum of 400 cases, with the following
minimum numbers applying:

• 200 related to the management of children less than five (5) years of age;

• 200 to the management of children of ages five (5) to fifteen (15) years;

• 50 cases classified as triage category 1 or 2 of which at least 25 must be children less than 5 years of
age; and

• 150 cases classified as triage category 1, 2 or 3.

For paediatric cases to be included in the portfolio, trainees must have provided substantive care to the
patient from the outset, including taking a history, performing a physical examination and participation in
management and disposition decisions. This must be documented in the patient’s clinical record by the
trainee.

When all paediatric WBAs have been completed, and the minimum number of cases have been logged in the
portfolio, this will trigger a review of the trainee’s Paediatric Emergency Requirement at the next relevant
Trainee Progression Review Panel meeting.

Examinations
Primary Examinations
The objective of the Primary Examinations, both Written and Oral, is to ensure that trainees possess the
required level of knowledge and understanding of the four basic medical sciences – Anatomy, Pathology,
Physiology and Pharmacology – as they form the foundation for the practice of emergency medicine.

Primary Written Examination – PEx(W) - is conducted online and consists of two 3-hour Multiple-Choice
Question (MCQ) papers.

Primary Oral Examination - PEx(VIVA) - is conducted at a testing centre and consists of four 10-minute
stations.

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The Foundations of Emergency Medicine section of the FACEM Curriculum provides guidance on the degree
to which each learning outcome is assessed in the Primary Examinations. These Levels of Assessment are:

― Level of Assessment 1 (LoA1):

Assessed in depth in the PEx(W) and the PEx(VIVA), addressing knowledge, comprehension, application
and/or analysis. Clinical integration of basic science concepts may be examined to the extent covered
by the relevant prescribed texts. Topics at this level will be examined more frequently than topics
assigned LoA 2 or 3.

― Level of Assessment 2 (LoA2):

Assessment in some detail in both PEx(W) and the PEx(VIVA), addressing knowledge, comprehension
and/or application. Clinical integration of basic science concepts may be examined to the extent
covered by the relevant prescribed examination texts. Topics at this level will be examined more
frequently than LoA3 but less frequently than LoA1.

― Level of Assessment 3 (LoA3):

Assessed less frequently than LoA1 and LoA2 learning outcomes, addressing knowledge and
comprehension only of overarching concepts and general principles involved in the topic without need
for fine detail.

Fellowship Examinations
The Fellowship Examinations, Written and Clinical, form a major part of the assessment in the latter stages
of the FACEM Training Program. These examinations test knowledge and skills at the level expected of a
junior Emergency Medicine Consultant. Whilst the examinations are stand-alone assessments, trainees
must pass the Fellowship Written Examination to be eligible to sit the Clinical Examination.

Fellowship Written Examination – FEx - is conducted online and consists of two 3-hour papers. The first is
comprised of a Short Answer Question (SAQ) paper, the second is a Multiple-Choice Question (MCQ) paper.
The examination is conducted at a number of testing centres around Australia and Aotearoa New Zealand.

Fellowship Clinical Examination - FEx – is an Objective Structure Clinical Examination (OSCE) conducted
over two consecutive days. It consists of twelve 11-minute clinical stations based on a variety of scenarios
that trainees would expect to see as part of their daily work in the emergency department, including history
taking, physical examinations, communication, procedural skills, simulations, resuscitation, teaching,
managing the ED, teamwork, case synthesis, creating management plans and interpreting investigation
results.

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3.2 Teaching and learning strategies and assessments key

Each of the learning outcomes of the FACEM Curriculum described in the tables throughout this document are
associated with teaching and learning strategies, and assessments. These have been abbreviated and the expanded
version can be found in the key below.

Table 4. Curriculum teaching and learning strategies and assessments key:

Abbreviation Meaning

Assessments WBA Workplace-based Assessment

ITA In-Training Assessment

RR Research Requirement

PR Procedural Requirement

PER Paediatric Emergency Requirement

PEx(W) Primary Examination (Written)

PEx(VIVA) Primary Examination (VIVA)

Fellowship Examination (Written

FEx and Objective Structured Clinical
Examination)
Teaching ST Supervised Training
and learning
strategies
SDL Self-directed Learning

SEP Structured Education Program

eLM e-Learning Module

WS Workshop

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4. Knowledge, skills and attributes for Emergency Medicine

Medical Expertise

Medical Expertise is the basis of practice as an Emergency Medicine Physician. The FACEM Curriculum describes
the required medical expertise as a scaffold (Figure 3), beginning with the basic medical sciences detailed in
the Foundations of Emergency Medicine, upon which the Principles of Practice in Emergency Medicine across
the patient journey through the emergency department are based, that are applied to the Clinical Management
of patients of all ages presenting to the emergency department, including those critically ill, injured and
undifferentiated.

Figure 3. Scaffold of Medical Expertise for Emergency Medicine Physicians.

Clinical Management in
Emergency Medicine

Acute Psychiatric and Geriatric

Cardiovascular
Addiction Gastrointestinal Respiratory
Renal and Urogenital Otolaryngologic
Paediatric Endocrinologic
Toxological and Oncological
Environmental
Haematologic
Rheumatological Principles of Practice in
Emergency Medicine Dermatological
Ophthalmologic
Obstetric and
Prehospital Care Focussed Assessment
Gynaecological
Immunological
Initial Emergency Analysis of
Neurological
Orthopaedic Care Investigations

Observational Documentation Metabolic

Infectious
Medicine and Handover
Disorders Foundations of Trauma
Resuscitation Patient
Medicine Emergency Medicine Disposition

Treatment Anatomy Ultrasound

Physiology
Pathology
Pharmacology

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| Medical Expertise |

1. Foundations of Emergency Medicine

1.1 Anatomy

By the end of Training Stage 1, trainees must demonstrate knowledge and understanding of anatomy as pertains
to emergency medicine.

Teaching and
Level of
Learning Outcomes Learning Assessment
assessment
Strategies
Demonstrate knowledge and understanding of:
+ Anatomical terminology, including 1
― Anatomical position
― Anatomical planes PEx(W)
SEP, SDL PEx (VIVA)
― Terms of relationship and comparison FEx
― Terms of laterality
― Terms of movement
+ Common anatomical variations 3 PEx(W)
SEP, SDL PEx(VIVA)
FEx
+ Anatomy of:
― Integumentary system 3
― Skeletal system, including cartilage, bones, bone 1
markings and formations, joints
― Muscular system, including muscle types – skeletal, 2
cardiac striated, smooth PEx(W)
― Fascial compartments, bursae, potential spaces, 1 SEP, SDL PEx(VIVA)
cartilage, bone markings, joints FEx
― Cardiovascular system, including vascular circuits and 2
vessels
― Lymphoid system 2
― Nervous system, including central, peripheral, somatic, 1
and autonomic systems
+ Anatomy of the thorax, including:
― Overview of the thorax 3
― Skeleton of the thoracic wall 1
― Thoracic apertures 3
― Fascia and joints of the thoracic wall 3
― Movements of thoracic wall 3
― Muscles, innervation and vascularisation of the
2
thoracic wall
― Breasts 2 PEx(W)
SEP, SDL PEx (VIVA)
― Surface anatomy of the thoracic wall 1
FEx
― Pleurae, lungs and tracheobronchial tree 1
― Overview of mediastinum 1
― Pericardium 2
― Heart 1
― Superior mediastinum and great vessels 1
― Posterior mediastinum 2
― Anterior mediastinum 3
― Surface anatomy of the heart and mediastinal viscera 1

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| Medical Expertise Foundations of Emergency Medicine |

Teaching and
Level of
Learning Outcomes Learning Assessment
assessment
Strategies
Demonstrate knowledge and understanding of:
+ Anatomy of the anterolateral abdominal wall, including:
― Overview, including walls, cavities, regions and planes 2
― Fascia and anterolateral abdominal wall 3
― Muscles and neurovasculature of the anterolateral PEx(W)
2
abdominal wall SEP, SDL PEx (VIVA)
― Internal surface of the anterolateral abdominal wall 3 FEx
― Inguinal region 1
― Spermatic cord, scrotum and testis 1
― Surface anatomy of the anterolateral abdominal wall 1
+ Anatomy of the peritoneum and subdivision of the PEx(W)
peritoneal cavity. 3 SEP, SDL PEx (VIVA)
FEx
+ Anatomy of abdominal viscera, including:
― Overview of abdominal viscera and digestive tract 2
PEx(W)
― Oesophagus, stomach, small and large intestines,
SEP, SDL PEx (VIVA)
spleen, pancreas, liver, biliary ducts and gallbladder, 2 FEx
kidneys, ureters and suprarenal glands
― Summary of innervation of abdominal viscera 2
+ Anatomy of the diaphragm, including:
― Vessels and nerves 1 PEx(W)
SEP, SDL PEx (VIVA)
― Diaphragmatic apertures 3 FEx
― Actions of the diaphragm 3
+ Anatomy of the posterior abdominal wall, including: PEx(W)
― Fascia and muscles of the posterior abdominal wall 3 SEP, SDL PEx (VIVA)
― Nerves and vessels of the posterior abdominal wall 2 FEx

+ Anatomy of the pelvis and perineum, including:

― Overview 2
― Bones and features of the pelvic girdle 1
― Orientation of the pelvic girdle and its joints and
2
ligaments
― Walls and floor of the pelvic cavity 2
― Peritoneum and peritoneal cavity of the pelvis 2
― Pelvic fascia 3 PEx(W)
― Nerves, arteries and veins of the pelvis 2 SEP, SDL PEx (VIVA)
FEx
― Lymph nodes of the pelvis 3
― Urinary organs and rectum 2
― Female internal genital organs 2
― Male internal genital organs 2
― Lymphatic drainage of pelvic viscera 3
― Fascia and pouches of urogenital triangle, male and
female urogenital triangles, and features of the anal 3
triangle

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Teaching and
Level of
Learning Outcomes Learning Assessment
assessment
Strategies
Demonstrate knowledge and understanding of:
+ Anatomy of the back and vertebral column, including:
― Overview 1
― Structure, function and regional characteristics of
1
vertebrae
― Joints, movements, curvature and vasculature of the
2
vertebral column
― Nerves of the vertebral column 1 PEx(W)
SEP, SDL PEx (VIVA)
― Extrinsic and intrinsic back muscles 3 FEx
― Surface anatomy of the back muscles 3
― Suboccipital and deep neck muscles 3
― Contents of the vertebral canal, including spinal cord,
spinal nerve roots, spinal meninges and cerebrospinal 1
fluid (CSF),
― Vasculature of spinal cord and spinal nerve roots 2
+ Anatomy of the lower limb, including:
― Overview of the lower limb 1
― Development of the lower limb 1
― Bones and joints of the lower limb, including surface
1
anatomy
― Subcutaneous tissue and fascia, venous drainage,
1
cutaneous and motor innervation
― Lymphatic drainage of the lower limb 2
― Posture and gait, including standing at ease and the
2
gait cycle
― Anterior and medial regions of thigh, including
PEx(W)
organisation, musculature, neurovasculature and 1
SEP, SDL PEx (VIVA)
surface anatomy FEx
― Gluteal and posterior regions of thigh, including the
2
buttocks and hip, muscles and neurovasculature
― Surface anatomy of the gluteal and posterior regions
1
of the thigh
― Popliteal fossa, including popliteal boundaries and
1
contents
― Contents of the anterior, lateral and posterior
1
compartments and surface anatomy of leg
― Skin, fascia, neurovasculature and surface anatomy of
1
the ankle and foot
― Muscles of the foot 2

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Teaching and
Level of
Learning Outcomes Learning Assessment
assessment
Strategies
Demonstrate knowledge and understanding of:
+ Anatomy of the upper limb, including:
― Overview 1
― Development of the upper limb 1
― Bones of the upper limb, including surface anatomy 1
― Fascia, venous drainage, cutaneous and motor
1
innervation
― Lymphatic drainage of the upper limb 2
― Surface anatomy and muscles of the pectoral, deltoid
1
and scapular regions of the upper limb
― Axilla, including boundaries, vasculature, lymph nodes
1
and brachial plexus
― Musculature, neurovasculature and surface anatomy of PEx(W)
1 SEP, SDL PEx (VIVA)
the arm
FEx
― Cubital fossa, including surface anatomy, boundaries
1
and contents
― Compartments of the forearm, including musculature,
1
neurovasculature and surface anatomy
― Hand, including fascia and compartments of the
palm, musculature, tendon and tendon sheaths, 1
neurovasculature and surface anatomy
― Sternoclavicular, acromioclavicular, and intercarpal
2
joints
― Glenohumeral, elbow, proximal and distal radio-
ulnar joints, wrist, carpometacarpal, intermetacarpal, 1
metacarpophalangeal and interphalangeal joints
+ Anatomy of the head, including:
― Overview 2
― Facial, lateral, occipital, and superior aspects of the
2
cranium
― Internal and external surfaces of the cranial base 2
― Walls of the cranial cavity 2
― Regions of the head 2
― Features, surface anatomy and nerves of the face and
1
scalp
― Muscles and superficial vasculature of the face and PEx(W)
2
scalp SEP, SDL PEx (VIVA)
― Cranial meninges 3 FEx
― Meningeal spaces 2
― Parts of the brain, including the ventricular system and
1
arterial blood supply
― Venous drainage of the brain 2
― Orbits, extraocular muscles, and nerves of the orbit 1
― Eyelids, eyeballs, lacrimal apparatus and vasculature of
2
the orbit
― Surface anatomy of the eye and lacrimal apparatus 1
― Parotid region 2

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Teaching and
Level of
Learning Outcomes Learning Assessment
assessment
Strategies
Demonstrate knowledge and understanding of:
+ Anatomy of the head continued
― Temporal region, infratemporal fossa and 3
temporomandibular joint
― Oral region, including oral cavity, lips, cheeks, gingivae,
2
teeth, tongue and salivary glands
― Palate 3
― Pterygopalantine fossa and pterygopalantine part of PEx(W)
3 SEP, SDL PEx (VIVA)
maxillary artery
FEx
― Maxillary nerve 2
― External nose, nasal cavities and neurovasculature of
2
the nose
― Paranasal sinuses 3
― External and middle ear 2
― Internal ear 3
+ Anatomy of the neck, including 3
― Overview 3
― Cervical vertebrae 1
― Hyoid bone 3
― Cervical subcutaneous tissue and platysma 3
― Deep cervical fascia 2
― Superficial structures of the neck, including
sternocleidomastoid, posterior, lateral and anterior
1
cervical regions, surface anatomy and triangles of the
neck PEx(W)
SEP, SDL PEx (VIVA)
― Prevertebral muscles and the root of the neck 2
FEx
― Respiratory layer of cervical viscera 1
― Endocrine and alimentary layers of cervical viscera 2
― Surface anatomy of endocrine and respiratory layers of
2
cervical viscera
― Lymphatics of the neck 2
― Optic, oculomotor, trochlear, trigeminal, abducent, and
1
facial nerves
― Glossopharyngeal, vagus, and spinal accessory nerves 2
― Olfactory, vestibulocochlear and hypoglossal nerves 3

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| Medical Expertise Foundations of Emergency Medicine |

1.2 Physiology

By the end of Training Stage 1, trainee must demonstrate knowledge and understanding of physiology as pertains
to emergency medicine.

Teaching and
Level of
Learning Outcomes Learning Assessment
assessment
Strategies
Demonstrate knowledge and understanding of:
+ Principles of cellular function. 1 PEx(W)
SEP, SDL PEx (VIVA)
FEx
+ Physiology of nerve cells, including:
PEx(W)
― General morphology and anatomy 3
SEP, SDL PEx (VIVA)
― Excitation, conduction, fibre types, neurotransmitters, 1 FEx
synapses and neuromuscular transmission
+ Physiology of muscle cells, including:
― General morphology and anatomy 2 PEx(W)
― Function, metabolism, and electrical and mechanical 1 SEP, SDL PEx (VIVA)
properties of skeletal and cardiac muscle FEx
― Morphology and properties of smooth muscle 2
2 PEx(W)
+ Mechanism of reflexes, such as monosynaptic and
SEP, SDL PEx (VIVA)
polysynaptic reflexes.
FEx
+ Physiology of smell and taste PEx(W)
3 SEP, SDL PEx (VIVA)
FEx
+ Physiology of sight, including: PEx(W)
― Anatomy, pathways and image-forming mechanisms 2 SEP, SDL PEx (VIVA)
― Eye movements 1 FEx

+ Physiology of hearing and equilibrium, including:

PEx(W)
― Anatomy, mechanisms of hearing and vestibular
2 SEP, SDL PEx (VIVA)
functions
FEx
― Role of hair cells 3
+ Physiology of alert behaviour, sleep/wake and electrical
activity of the brain, including: PEx(W)
SEP, SDL PEx (VIVA)
― Overview 3
FEx
― Seizures 2
+ Principles of control of posture and movement, including: PEx(W)
― Corticospinal and corticobulbar system, cerebellum 1 SEP, SDL PEx (VIVA)
― Role of the midbrain and basal ganglia 3 FEx

+ Physiology of the autonomic nervous system, including PEx(W)

anatomy, transmitters and effects. 2 SEP, SDL PEx (VIVA)
FEx
+ Physiology of learning and memory. PEx(W)
3 SEP, SDL PEx (VIVA)
FEx

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Teaching and
Level of
Learning Outcomes Learning Assessment
assessment
Strategies
Demonstrate knowledge and understanding of:
+ Principles of endocrinology.
― Hypothalamic function, vasopressin and temperature
1
regulation
― Anatomic, cyclic and autonomic considerations 3 PEx(W)
SEP, SDL PEx (VIVA)
― Water regulation, including diuresis and thirst 2
FEx
― Control of anterior pituitary secretion 2
― Control of posterior pituitary secretion of oxytocin 3
― Control of posterior pituitary secretion of vasopressin 1
+ Physiology of the pituitary gland, including: 1
― Morphology 2
― Intermediate-lobe hormones 2 PEx(W)
― Growth hormone 2 SEP, SDL PEx (VIVA)
― Physiology of growth 2 FEx

― Pituitary insufficiency 1
― Pituitary hyperfunction 2
+ Physiology of the adrenal medulla and adrenal cortex,
including:
― Adrenal morphology 2
― Adrenal medulla and medullary hormones 1 PEx(W)
― Adrenal cortex and cortical hormone synthesis/ SEP, SDL PEx (VIVA)
2
metabolism FEx
― Glucocorticoids 1
― Regulation of glucocorticoid secretion 2
― Mineralocorticoids 1
+ Physiology of the thyroid gland and thyroid hormones. PEx(W)
2 SEP, SDL PEx (VIVA)
FEx
+ Hormonal control of calcium and phosphorus metabolism
and the physiology of bone including:
― Calcium and phosphorus metabolism 1
― Bone physiology 2 PEx(W)
SEP, SDL PEx (VIVA)
― Vitamin D and the hydroxycholecalciferols 3
FEx
― Parathyroid glands 1
― Calcitonin 3
― Other renal hormones 3
+ Principles of reproductive physiology, including
― Sex differentiation and development 3
― Pituitary gonadotropins and prolactin 3 PEx(W)
― Male reproductive system 2 SEP, SDL PEx (VIVA)
― Female reproductive system 2 FEx

― Pregnancy 1
― Lactation 2

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Teaching and
Level of
Learning Outcomes Learning Assessment
assessment
Strategies
Demonstrate knowledge and understanding of:
+ Endocrine functions of the pancreas, including:
― Islet cell structure 3
― Insulin and regulation of insulin secretion 1 PEx(W)
SEP, SDL PEx (VIVA)
― Disorders of glucose metabolism 1 FEx
― Glucagon 1
― Other islet cell hormones 3
+ Physiology of gastrointestinal function, including: 2
― Mouth and oesophagus 2
― Stomach 2
― Exocrine portion of the pancreas 2 PEx(W)
SEP, SDL PEx (VIVA)
― Liver and biliary system 1 FEx
― Small and large intestines 2
― Gastrointestinal hormones 2
― Gastrointestinal motility 2
+ Physiology of digestion, absorption and nutrition, including:
― Carbohydrates 2
― Proteins and nucleic acids 3 PEx(W)
SEP, SDL PEx (VIVA)
― Lipids 2 FEx
― Absorption of water and electrolytes 1
― Absorption of vitamins and minerals 2
+ Cardiovascular physiology, including:
― Cardiac excitation 1
― Electrocardiogram 1
― Cardiac arrhythmias 1
PEx(W)
― Electrocardiographic findings in other diseases 1
SEP, SDL PEx (VIVA)
― Mechanical events of the cardiac cycle 1 FEx
― Cardiac output 1
― Cardiac function in health and disease 1
― Regulatory mechanisms, local regulation, hormonal
1
regulation, regulation by the nervous system
+ Physiology and dynamics of circulating body fluids,
including:
― Bone marrow 1
― Blood cell types 1
― Haemoglobin 1 PEx(W)
SEP, SDL PEx (VIVA)
― Platelets 1
FEx
― Blood types 1
― Plasma 1
― Haemostasis 1
― Lymph 3
+ Dynamics of circulating body fluids, including:
― Biophysics 1 PEx(W)
― Blood circulation, vessels 1 SEP, SDL PEx (VIVA)
― Lymphatic circulation 2 FEx

― Interstitial fluid 1

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| Medical Expertise Foundations of Emergency Medicine |

Teaching and
Level of
Learning Outcomes Learning Assessment
assessment
Strategies
Demonstrate knowledge and understanding of:
+ Circulation through special regions, including:
― Cerebral circulation 1
― Coronary circulation 1
― Pulmonary circulation 1 PEx(W)
SEP, SDL PEx (VIVA)
― Renal circulation 1 FEx
― Splanchnic circulation 2
― Cutaneous circulation 2
― Placental and foetal circulation 2
+ Physiology of respiration, including;
― Anatomy, structure, function 1
― Control of ventilation 1
― Gas diffusion 1
― Pulmonary circulation 1 PEx(W)
― Ventilation-perfusion relationships 1 SEP, SDL PEx (VIVA)
― Gas transport by the blood 1 FEx

― Mechanics of breathing 1
― Respiratory system under stress 2
― Tests of pulmonary function 3
― Forced expiration 2
+ Physiology of the renal system, including
― Anatomy 2
― Renal circulation 1
PEx(W)
― Glomerular filtration 1
SEP, SDL PEx (VIVA)
― Tubular physiology, regulation of water and electrolyte FEx
1
excretion
― Renal function disorder and diuretics 1
― The bladder 2
+ Regulation of extracellular fluid composition, volume and
acid-base balance, including
― Tonicity 1
― Volume 1 PEx(W)
SEP, SDL PEx (VIVA)
― Renin-Angiotensin system 1
FEx
― Natriuretic factors 2
― H+ and bicarbonate regulation 1
― Acidosis and alkalosis 1

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| Medical Expertise Foundations of Emergency Medicine |

1.3 Pathology

By the end of Training Stage 1, trainees must demonstrate knowledge and understanding of pathology relevant to
emergency medicine.

Teaching and
Level of
Learning Outcomes Learning Assessment
assessment
Strategies
Demonstrate knowledge and understanding of:
+ Principles of pathology, including mechanisms of cellular 1 PEx(W)
injury, cellular adaptation, and acute and chronic SEP, SDL PEx (VIVA)
inflammation. FEx
+ Principles of tissue renewal and repair, including vascular 2 PEx(W)
responses to injury, and processes of healing, scar SEP, SDL PEx (VIVA)
formation, fibrosis, and fibrosis. FEx
1 PEx(W)
+ Principles of cutaneous wound healing. SEP, SDL PEx (VIVA)
FEx
+ Fluid and haemodynamic derangements, including: 1
― Oedema
― Hyperaemia and congestion
― Haemorrhage PEx(W)
― Thrombosis SEP, SDL PEx (VIVA)
― Haemostasis FEx

― Embolism
― Infarction
― Shock
+ Features of the immune system and diseases of immunity,
2
including
― Normal immune response 2 PEx(W)
― Hypersensitivity reactions, 1 SEP, SDL PEx (VIVA)
― Immunological tolerance and causative mechanisms of FEx
3
autoimmune disease
― Acquired immunodeficiency syndrome (AIDS) 3
+ Principles of neoplasia, including: 3
― characteristics of benign and malignant neoplasms 1
― Epidemiology 3 PEx(W)
SEP, SDL PEx (VIVA)
― Molecular basis of cancer 3 FEx
― Carcinogenic agents 3
― Clinical features of tumours 2
+ Principles of infectious disease, including: 2
― General principles of microbial pathogenesis 1
― Viral infections 2
― CMV, Epstein-Barr, Hepatitis viruses, herpes simplex,
1
HIV, influenza, measles, mumps, varicella-zoster viruses PEx(W)
― Bacterial infections such as chlamydia, rickettsia, SEP, SDL PEx (VIVA)
1 FEx
mycoplasma
― General features of other infectious diseases, such as
3
fungi, protozoa and helminths
― Malaria 2
― Emerging infectious diseases 3

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Teaching and
Level of
Learning Outcomes Learning Assessment
assessment
Strategies
Demonstrate knowledge and understanding of:
+ Principles of environmental pathology, including: 3
― Personal exposure 3
― Therapeutic drugs 1
― Nontherapeutic agents 1 PEx(W)
― Air pollution 3 SEP, SDL PEx (VIVA)
― Heavy metals and industrial exposure 3 FEx

― Radiation 3
― Physical injuries 1
― Nutritional pathology 3
+ Blood vessel injury and disease, including: 2
― Vascular response to injury 2
― Hypertensive vascular disease 2
― Atherosclerosis 1 PEx(W)
SEP, SDL PEx (VIVA)
― Aneurysms and dissections 1 FEx
― Vasculitides 3
― Veins and lymphatic 3
― Vascular intervention 3
+ Principles of cardiac disease, including: 1
― Heart failure 1
― Ischaemic heart disease 1
― Arrythmias 1 PEx(W)
― Valvular heart disease 2 SEP, SDL PEx (VIVA)
― Cardiomyopathies 1 FEx

― Pericardial disease 1
― Congenital heart disease 3
― Transplantation 3
+ Principles of blood cell disorders, including: 3
― Normal development of blood cells 3
― Anaemias 2
― Polycythaemia 3
― Bleeding disorders 2 PEx(W)
SEP, SDL PEx (VIVA)
― Blood groups, transfusions 2 FEx
― Leukopenia 2
― Inflammatory white cell proliferation 2
― Neoplastic white cell proliferation 3
― Splenomegaly 3

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Teaching and
Level of
Learning Outcomes Learning Assessment
assessment
Strategies
Demonstrate knowledge and understanding of:
+ Principles of lung disease, including: 2
― Atelectasis 3
― Pulmonary congestion and oedema 1
― Acute lung injury 1
― Obstructive airways disease 1 PEx(W)
― Diffuse interstitial disease 3 SEP, SDL PEx (VIVA)
― Disease of vascular origin 3 FEx

― Pulmonary infections 1
― Tumours 2
― Pleural pathology 2
― Hyperbaric oxygen 3
+ Principles of disorders and diseases of the gastrointestinal
2
tract, including:
― Oesophagitis 2
― Oesophageal varices 1
PEx(W)
― Gastritis 2 SEP, SDL PEx (VIVA)
― Intestinal obstruction 1 FEx
― Ischaemic bowel disease 1
― Intestinal inflammatory disorders 2
― Malabsorption syndromes 3
+ Principles of liver and biliary tract disease, including: 1
― General features of hepatic disease and liver failure 1
― Infectious disorders 1 PEx(W)
SEP, SDL PEx (VIVA)
― Alcoholic liver disease 1 FEx
― Cholelithiasis 1
― Cholecystitis 1
+ Principles of pancreatic disease, including: 2 PEx(W)
― Acute pancreatitis 1 SEP, SDL PEx (VIVA)
― Chronic pancreatitis 3 FEx

+ Principles of renal disease, including: 2

― Glomerular disease 3
― Tubular and interstitial disease 2 PEx(W)
SEP, SDL PEx (VIVA)
― Hypertensive renal disease 3 FEx
― Urinary tract obstruction 1
― Urolithiasis 1
+ Principles of genitourinary pathology, including: 3
― Disorders and diseases of the testes 2
― Disorders and diseases of the prostate 3 PEx(W)
SEP, SDL PEx (VIVA)
― Disorders and diseases of the female genital tract 3 FEx
― Miscarriage, ectopic pregnancy 1
― Other gestational disorders 2

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Teaching and
Level of
Learning Outcomes Learning Assessment
assessment
Strategies
Demonstrate knowledge and understanding of:
+ Principles of endocrine pathology, including diseases and
3
disorders of the:
― Pituitary 3
PEx(W)
― Thyroid 2 SEP, SDL PEx (VIVA)
― Parathyroid 3 FEx
― Endocrine pancreas 1
― Adrenal cortex and medulla 2
+ Principles of musculoskeletal pathology, including: 3
― Bone remodelling, growth and development 3
― Osteoporosis 3
― Paget’s disease 3 PEx(W)
SEP, SDL PEx (VIVA)
― Fractures 1 FEx
― Osteonecrosis 3
― Osteomyelitis 1
― Arthritis 2
+ Principles of peripheral neurological and skeletal muscle
3
pathologies, including:
PEx(W)
― Peripheral neuropathies 3 SEP, SDL PEx (VIVA)
― Diseases of the neuromuscular junction 3 FEx
― Disease of skeletal muscle 3
+ Principles of central nervous system diseases and disorders,
2
including:
― Cerebral oedema and raised intracranial pressure 1
― Trauma 1
PEx(W)
― Cerebrovascular disease 1 SEP, SDL PEx (VIVA)
― Infections 1 FEx
― Demyelinating disease 3
― Degenerative diseases 3
― Toxic and acquired metabolic diseases 3
+ Principles of common diseases and disorders of the eye and PEx(W)
sight. 3 SEP, SDL PEx (VIVA)
FEx
+ Principles of genetic disorders. PEx(W)
3 SEP, SDL PEx (VIVA)
FEx
+ Principles of diseases and disorders of teeth and supporting PEx(W)
structures. 3 SEP, SDL PEx (VIVA)
FEx
+ Principles of diseases and disorders of childhood, including: 3
― Perinatal infections 2 PEx(W)
SEP, SDL PEx (VIVA)
― Cystic fibrosis 3 FEx
― Sudden Infant Death Syndrome (SIDS) 2
+ Principles of common diseases and disorders of the skin,
3
including
PEx(W)
― Melanoma 2 SEP, SDL PEx (VIVA)
― Other epidermal malignancies 3 FEx
― Rashes, lumps, lesions and ulcers 3

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| Medical Expertise Foundations of Emergency Medicine |

1.4 Pharmacology

By the end of Training Stage 1, trainees must demonstrate knowledge and understanding of pharmacology
relevant to emergency medicine.

Teaching and
Level of
Learning Outcomes Learning Assessment
assessment
Strategies
Demonstrate knowledge and understanding of:
+ General principles of pharmacology, including:
― Pharmacokinetics – absorption, distribution, 1
biotransformation, elimination kinetics
PEx(W)
― Pharmacodynamics – mechanisms of action, receptors 1
SEP, SDL PEx (VIVA)
and their regulation, second messengers/ G protein, FEx
dose response, dosing issues
― Prescribing – drugs in the elderly, in children, in 2
pregnancy
+ Pharmacology of specific agents employed in disorders and
diseases of the respiratory system, including:
― Methylxanthines 2
― Sympathomimetic agents 1 PEx(W)
SEP, SDL PEx (VIVA)
― Disodium cromoglycate 3
FEx
― Muscarinic antagonists 1
― Antitussives 3
― Steroids in respiratory disease 1
+ Pharmacology of specific agents employed in disorders and
1
diseases of the cardiovascular system, including:
― Emergency cardiac drugs, including inotropes 1
― Antianginal drugs, such as nitrates, calcium channel
1
blockers and beta blockers
― Antiarrhythmic agents, such as class 1b sodium
channel blockers, class 2 beta blockers, class 3
2
potassium channel blockers, class 4 calcium channel
blockers, adenosine, and magnesium
― Class 1a and 1c sodium channel blockers 1
― Cardiac glycosides 1
― Antihypertensives, including PEx(W)
beta blockers; SEP, SDL PEx (VIVA)
1
ACE inhibitors, angiotensin receptor blockers, 2 FEx
vasodilators, centrally acting sympathoplegics, alpha
blockers; and
adrenergic neuro-blocking agents. 3
― Diuretics, including
loop diuretics; and 1
thiazide diuretics, potassium sparing diuretics, osmotic 2
diuretics, carbonic anhydrase inhibitors.
― Drugs affecting haemostasis, thrombosis, and the
haemopoietic system, including
anti-platelet agents, anticoagulants, thrombolytics; 1
antifibrinolytics; and 2
3
haemopoietic agents.
― Drugs used in dyslipidaemia, including
statins; and 2
fibrates and other drugs. 3

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Teaching and
Level of
Learning Outcomes Learning Assessment
assessment
Strategies
Demonstrate knowledge and understanding of:
+ Pharmacology of specific agents used in diseases and
disorders of the nervous system, including:
― Neurotransmitters 2
― Drugs acting on the sympathetic and parasympathetic
1
nervous systems
― Local anaesthesia 1
― General anaesthesia agents, including
induction agents, muscle relaxants, nitrous oxide 1
neuromuscular reversal agents 2
volatile anaesthetics 3
― Antipsychotic agents 3
― Antidepressives, including
Tricyclics, lithium 1 PEx(W)
Serotonin-reuptake inhibitors, other agents 2 SEP, SDL PEx (VIVA)
FEx
― Anticonvulsants:
phenytoin, carbamazepine, sodium valproate, 1
levetiracetam
all other anticonvulsants 3
― Hypnotics/sedatives, including
Benzodiazepines, barbiturates 1
Newer agents 3
― Alcohols, including
Ethanol, methanol, ethylene glycol 1
Drugs used in acute alcohol withdrawal 1
Drugs used in chronic alcoholism 3
― Anti-Parkinsonian agents 3
― Anti-migraine agents 2
+ Pharmacology of antimicrobial agents, including
― Principles of their action 1
― Beta lactam agents 1
― Aminoglycosides 2
― Sulphonamides 2
― Quinolones 2
― Antimycobacterial agents 3
― Metronidazole 1
― Antifungals 3 PEx(W)
SEP, SDL PEx (VIVA)
― Antivirals, including HIV prophylaxis 2 FEx
― Disinfectants 2
― Mechanisms of resistance 2
― Antiprotozoals, antiparasitics, anthelminthics 3
― Macrolide agents 2
― Tetracyclines 2
― Vancomycin 2
― Lincosamides 2
― Other antimicrobial agents 3

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| Medical Expertise Foundations of Emergency Medicine |

Teaching and
Level of
Learning Outcomes Learning Assessment
assessment
Strategies
Demonstrate knowledge and understanding of:
+ Pharmacology of the immune system, including
― Histamine antagonists 2
― Serotonergic agents 3 PEx(W)
― Eicosanoids 3 SEP, SDL PEx (VIVA)
― Vaccines 3 FEx

― Immunoglobulins 3
― Cancer chemotherapy agents 3
+ Pharmacology of agents employed in disorders and diseases
of the endocrine system, including
― Insulin, sulfonylureas/biguanides 1
― Other drugs used in the management of diabetes 3
― Glucocorticoids 1
― Mineralocorticoids 2 PEx(W)
SEP, SDL PEx (VIVA)
― Sex hormones 3
FEx
― Thyroxine 2
― Anti-thyroid drugs 3
― Hypothalamic/pituitary hormone agents 3
― Drugs affecting bone metabolism 3
― Octreotide 2
+ Pharmacology of agents employed in diseases and disorders
of the gastro-intestinal tract, including
― Antiemetics 1
― Antidiarrhoeal 3
― Laxatives 3 PEx(W)
― Anti-ulcer medications, including SEP, SDL PEx (VIVA)
H2 receptor antagonists; 2 FEx
Proton pump inhibitors; and 1
Other drugs 3
― Antispasmodics 2
― Topical rectal agents 3
+ Pharmacology of analgesics and anti-inflammatory agents,
including
― Aspirin 1
― Non-steroidal anti-inflammatory drugs 2
PEx(W)
― Paracetamol 1 SEP, SDL PEx (VIVA)
― Anti-gout agents 2 FEx
― Steroids 1
― Opiates 1
― Disease modifying anti-rheumatic drugs 3

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Teaching and
Level of
Learning Outcomes Learning Assessment
assessment
Strategies
Demonstrate knowledge and understanding of:
+ Pharmacological principles of toxicology and toxinology,
including
― Activated charcoal 1
― Antidotes, including:
N-Acetyl cysteine
Naloxone 1
1
Flumazenil PEx(W)
1
Sodium bicarbonate SEP, SDL PEx (VIVA)
1
Antivenoms 2 FEx
Chelating agents 3
Digoxin antibody fragments 2
Oximes 3
― Toxidromes 1
― Drugs of abuse 2
― Occupational and environmental pollutants 3
+ Pharmacology of fluids and electrolytes, including
― Intravenous fluid solutions 1
― Potassium 1 PEx(W)
SEP, SDL PEx (VIVA)
― Calcium 1 FEx
― Sodium 1
― Magnesium 1
+ Pharmacology of vitamins, including
― Vitamin K 1 PEx(W)
SEP, SDL PEx (VIVA)
― Vitamin B1 2 FEx
― Other vitamins 3
+ Pharmacology of common ophthalmic agents PEx(W)
2 SEP, SDL PEx (VIVA)
FEx
+ Pharmacology of agents employed in the prevention and PEx(W)
treatment of genitourinary infections 3 SEP, SDL PEx (VIVA)
FEx
+ Pharmacology of common dermatologic agents PEx(W)
3 SEP, SDL PEx (VIVA)
FEx

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| Medical Expertise |

2. Principles of Practice in Emergency Medicine

Principles of medical expertise specific to the provision of immediate recognition, evaluation, care, stabilisation,
and disposition of a diverse population of adult and paediatric patients in response to acute or episodic illness
and injury in hospital emergency departments, prehospital settings, clinics, community health centres, and
aeromedical environments.

2.1 Prehospital Care

By the end of the relevant stage of training, demonstrate clinical expertise in the management of a patient prior
to their arrival in the emergency department.

Teaching and
Training
Learning Outcomes Learning Assessment
stage
Strategies
TS1 Be able to:
1.1 Assist in preparing to accept a patient on arrival to the ED via
ambulance.
ST ITA, FEx
1.2 Acknowledge the risks of providing telephone advice.
1.3 Redirect incoming callers appropriately, as required.
TS2 Be able to:
2.1 Gather and seek relevant information prior to an expected patient’s
arrival.
2.2 Utilise a structured approach to accepting communication regarding
the arrival of trauma patients from prehospital clinicians.
ST ITA, FEx
2.3 Activate the appropriate predetermined hospital response prior to a
patient’s arrival.
2.4 Provide appropriate site-specific advice regarding limitations in patient
care delivery.
TS3 Demonstrate knowledge and understanding of:

3.1 Limitations of patient transport modalities, and the challenges of

performing clinical intervention during transport.
3.2 Physiological responses to changes encountered within the transport
environment, including the effect of prolonged transfer. SEP, SDL, WBA, ITA,
3.3 Strategies used to mitigate the effects of the transport environment on ST FEx
patients
3.4 Medical, physical and psychological factors that influence management
of a patient on scene.

Be able to:

3.5 Interpret gathered information prior to an expected patient’s arrival.

3.6 Prepare to accept and resuscitate an expected patient.
3.7 Dispense clear, simple guidance for patients and doctors phoning for
advice, including appropriate time critical instructions.
ST ITA, FEx
3.8 Incorporate knowledge of the caller’s local health resources when
giving advice to off-site clinicians.
3.9 Advise on the need for transfer and appropriate mode of transport for
a patient transfer.

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| Medical Expertise Principles of Practice in Emergency Medicine |

Teaching and
Training
Learning Outcomes Learning Assessment
stage
Strategies
TS4 Be able to:

4.1 Consider departmental and hospital activity when accepting a patient

transfer.
4.2 Direct a patient transfer from the pre-hospital environment to the most WBA, ITA,
ST
appropriate health care facility. FEx
4.3 Advise off-site clinicians on resuscitative measure and further
management.

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| Medical Expertise Principles of Practice in Emergency Medicine |

2.2 Initial Emergency Medicine Care

By the end of the relevant stage of training, demonstrate clinical expertise in the provision of initial emergency
medicine care.

Teaching and
Training
Learning Outcomes Learning Assessment
stage
Strategies
TS1 Be able to:
1.1 Perform a rapid and focussed initial patient assessment of a non-
critically ill patient, in a culturally safe manner, prior to their entry into
the main area of the ED, in order to: WBA, ITA,
ST
(a) Choose and arrange appropriate investigations FEx
(b) Provide appropriate first aid treatment for common symptoms
(c) Escalate care when high-risk features are identified.
TS2 Be able to:
2.1 Perform a structured initial assessment on a critically ill patient in a
culturally safe manner.
WBA, ITA,
2.2 Initiate transfer of the patient from the triage area to the most ST
FEx
appropriate location in the emergency department.
2.3 Initiate appropriate time critical intervention
TS3 Be able to:

3.1 Perform a modified risk assessment based on identified high-risk

features, taking into account cultural considerations, and arrange time
critical investigations.
3.2 Initiate appropriate initial supportive treatment for any presenting
WBA, ITA,
problem. ST
FEx
3.3 Generate a provisional and differential diagnosis from minimal
information.
3.4 Utilise an increased range of medical and physical therapies to provide
initial targeted management.
TS4 Be able to:

4.1 Simultaneously, perform initial patient assessment and commence WBA, ITA,
ST
initial treatment in a patient. FEx

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| Medical Expertise Principles of Practice in Emergency Medicine |

2.3 Resuscitation Medicine

The core business for Emergency Medicine Physicians is the assessment of patients with undifferentiated
clinical presentations, particularly those that are of a life/limb/sight threatening nature and require immediate
resuscitation, including:
• Acute confusion/aggression • Extreme temperature abnormalities
• Acute dizziness • Major burn
• Acute headache • Major haemorrhage
• Acute pain • Major head/spinal injury
• Acute weakness • Major limb injury
• Altered conscious state/coma • Major torso injury
• Airway compromise • Missed essential therapy (e.g.,
• Apnoea dialysis, medications)
• Arrhythmia with shock • Seizure
• Cardiorespiratory arrest • Severe dyspnoea
• Critical toxic ingestion/exposure • Shock
• Envenomation • Syncope
By the end of the relevant stage of training, demonstrate clinical expertise in the management of patients
requiring resuscitation in the emergency department.

Teaching and
Training
Learning Outcomes Learning Assessment
stage
Strategies
TS1 Be able to:
1.1 Consistently use an ABDCE approach to the initial assessment of a
patient requiring resuscitation.
1.2 Commence and follow appropriate resuscitation protocols and
algorithms, with the understanding that resuscitation has a defined
endpoint.
1.3 Assess and support airway and ventilation.
1.4 Recognise shock and pre-shock states in patients and initiate basic
SEP, SDL, WBA, ITA,
circulatory resuscitation.
ST FEx
1.5 Perform a brief neurological assessment, with a focus on level of
consciousness, pupillary activity and peripheral nervous system
assessment.
1.6 Initiate simple interventions to optimise and support the patient’s
neurological function.
1.7 Initiate appropriate non-invasive temperature control measures.
1.8 Identify patients that may require decontamination.

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| Medical Expertise Principles of Practice in Emergency Medicine |

Teaching and
Training
Learning Outcomes Learning Assessment
stage
Strategies
TS1 1.9 Independently perform the following procedures:
continued (a) Basic airway manoeuvres in an adult or a child, including
chin lift, jaw thrust, head tilt and positioning
(b) Insertion of oropharyngeal or nasopharyngeal airway
(c) Use of oxygen delivery devices
(d) Use of self-inflating bag for ventilation
(e) Adult, child and infant external chest compressions
(f) Defibrillation
(g) Venepuncture
(h) Adult peripheral intravenous access, including large bore SEP, SDL, WBA, ITA,
(16G) ST FEx
(i) Arterial puncture or blood sampling
(j) Preparation of an intravenous fluid or blood product line
(k) Insertion of a nasogastric tube or orogastric tube
(l) Insertion of an adult urinary catheter
(m) Sizing and application of a rigid cervical collar
(n) In-line cervical spine immobilisation
(o) Full spinal immobilisation, log roll and transfer
(p) Interpret pulse oximetry
(q) Interpret end-tidal CO2
TS2
Be able to:

2.1 Apply understanding of basic sciences and common resuscitative

treatments to the performance of a systematic concurrent
assessment and resuscitation using first line therapeutic
interventions.
2.2 Institute targeted first line circulatory resuscitation.
2.3 Demonstrate an approach to the management of:
(a) Abnormalities in airway and/or ventilation
SEP, SDL, WBA, ITA,
(b) Severe abnormalities in circulation
ST FEx
(c) Temperature trends in resuscitation
2.4 Assess the airway of a critically ill patient prior to performing
definitive treatment.
2.5 Perform a focused neurological assessment specifically aimed at
detecting or ruling out specific pathologies.
2.6 Initiate basic invasive temperature control measures targeted at a
defined treatment goal.

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| Medical Expertise Principles of Practice in Emergency Medicine |

Teaching and
Training
Learning Outcomes Learning Assessment
stage
Strategies
TS2 2.7 Independently perform the following procedures:
continue (a) Insertion of a laryngeal mask airway
(b) Spirometry and peak flow measurement
(c) Use adult non-invasive inflation device
(d) Paediatric peripheral intravenous access
(e) Insertion of a rapid infusion catheter
(f) Intraosseous access
SEP, SDL, WBA, ITA,
(g) Preparation and operation of transport monitoring ST FEx
equipment
(h) Replacement of suprapubic catheter
(i) Abdominal paracentesis and insertion of drain
(j) Emergent fracture/dislocation reduction
(k) Application of pelvic binding device
(l) Application of traction splinting device
(m) Administration of chemical restraint
TS3
Demonstrate knowledge and understanding of:

3.1 Indirect laryngoscopy (use of dental mirror to examine for foreign WBA, ITA,
ST
body). FEx

Be able to:

3.2 Complete a systematic concurrent assessment and resuscitation

using a broader range of therapeutic interventions.
3.3 Synthesise clinical information found on initial assessment to form
both a provisional diagnosis and a differential diagnosis.
3.4 Secure a definitive airway and successfully ventilate the patient.
3.5 Anticipate and act to prevent complications in the management of
airway and/or ventilation.
3.6 Initiate advanced circulatory resuscitation targeted at defined
treatment goals.
3.7 Arrange appropriate ongoing supportive management during and
after resuscitation.
3.8 Proactively search for life threatening conditions and perform SEP, SDL, WBA, ITA,
lifesaving interventions, as required. ST FEx
3.9 Recognise scenarios where ongoing resuscitation may be non-
beneficial.
3.10 Demonstrate an approach to the “can’t intubate, can’t oxygenate”
scenario.
3.11 Establish the likely aetiology of the shocked state.
3.12 Anticipate and prevent complications from shock and its treatment.
3.13 Initiate treatments specific to neurological pathologies.
3.14 Anticipate and act to prevent secondary neurological injury.
3.15 Anticipate and act to prevent the potential complications of body
temperature control and management.

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| Medical Expertise Principles of Practice in Emergency Medicine |

Teaching and
Training
Learning Outcomes Learning Assessment
stage
Strategies
TS3 3.16 Independently perform the following procedures:
continued (a) Video laryngoscopy and other rescue/difficult airway devices
(b) Extubation
(c) Set up a transport ventilator
(d) Decompression needle/finger thoracostomy
(e) Pleurocentesis
(f) Tube thoracostomy
(g) DC cardioversion
(h) External pacing
(i) Arterial line insertion
(j) Insertion of a central venous line
(k) Emergency pericardiocentesis
(l) Insertion of an infant urinary catheter SEP, SDL, WBA, ITA,
ST FEx
(m) Suprapubic aspiration of urine in an infant
(n) Insertion of a suprapubic catheter
(o) Insertion of oesophageal and gastric balloon devices
(p) Emergency replacement of a dislodged gastrostomy tube
(q) Interpret capnography
(r) Administer procedural sedation
(s) Regional anaesthesia, including Biers Block
(t) Direct laryngoscopy, insertion of oral ETT, use of RSI
technique (including drugs, stylet, bougie)
(u) Secure and care for ETT, including during transport
(v) Haemorrhage control, including facial packing/tamponade,
pressure dressing, tourniquet application, haemostatic
suturing of lacerations, wound stapling
TS4
Demonstrate knowledge and understanding of:

4.1 Principles of resuscitative thoracotomy, including indications and

contraindications.
4.2 Principles of resuscitative hysterotomy, including indications and SEP, SDL, WBA, ITA,
contraindications. ST FEx
4.3 Principles of other types of endo-tracheal tubes, including nasal and
double lumen including indications and contraindications.

Be able to

4.4 Adapt resuscitation skills to any patient presentation of any

complexity.
4.5 Define the treatment goals for resuscitation.
4.6 Recognise and expedite any specific intervention essential to
resuscitation.
4.7 Cease resuscitation when a defined endpoint is reached. SEP, SDL, WBA, ITA,
4.8 Apply knowledge of clinical injury and illness outcomes when ST FEx
counselling and debriefing after resuscitation.
4.9 Definitively manage the “can’t intubate, can’t oxygenate” scenario.
4.10 Adapt management of any circulatory emergency.
4.11 Incorporate definitive neurological interventions within a
resuscitative management plan.

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Strategies
TS4 4.12 Initiate advanced invasive temperature control measures.
continued
4.13 Independently perform the following procedures under simulation:
(a) Insertion of cricothyroid needle and jet insufflation of
oxygen
SEP, SDL, WBA, ITA,
(b) Cricothyroidotomy in an adult ST FEx
(c) Emergency replacement of blocked or dislodged
tracheostomy tube
(d) Use non-self-inflating bag for ventilation
(e) Use paediatric device

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2.4 Focused Assessment

Presentations list
Focused assessment of patients with undifferentiated presentations in emergency departments occurs
irrespective of immediate resuscitation measures that may be required. Those presentations include:

• Abdominal pain/distension • Foreign body

• Abnormal test result • Hallucinations/psychosis
• Altered behaviour • Headache
• Altered motor function • Hypertension
• Altered mood • Infection/infestation
• Altered sensation • Injury
• Anxiety • Jaundice
• Behaviour disturbance • Lethargy
• Bite/sting • Limp
• Bleeding • Lump
• Breathing difficulty • Minor limb injury
• Burn • Mobility/movement problems
• Collapse • Pain
• Complication of treatment/procedure • Pregnancy
• Confusion/disorientation • Poisoning
• Constipation • Rash
• Contusion • Skin lesion
• Cough • Situational crisis
• Deformity • Social crisis
• Dehydration • Speech disturbance
• Delusion • Sprain/strain
• Diarrhoea • Swelling/oedema
• Discharge/exudate • Urinary dysfunction
• Dizziness • Visual loss/disturbance
• Drug/medication related presentation • Vomiting
• Dyspnoea • Weakness
• Erythema • Weight loss
• Falls/unsteadiness • Wound
• Feeding problems
• Fever

By the end of the relevant stage of training, trainees must demonstrate clinical expertise in undertaking a
focused assessment on patients in the emergency department.

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TS1 Demonstrate knowledge and understanding of:

1.1 Importance of accurate history taking as the major contributor to the
SEP, SDL,
diagnostic process. WBA, ITA, FEx
ST
1.2 Impact of social and cultural factors on the patient’s history.

Be able to:

1.3 Use universal precautions when performing any assessment.

1.4 Consistently use a patient-centred approach when performing
patient assessment, taking into account gender, sexuality, cultural
background and religious beliefs.
1.5 Identify the presence or absence of relevant physical signs in an
appropriate examination, taking into account how social and cultural
differences impact upon physical examination findings.
1.6 Perform a detailed subsequent systematic culturally sensitive
assessment in patients with more complex presentations.
1.7 Develop a problem list for a patient presentation, taking into
consideration the patient’s social and cultural background.
1.8 Generate a differential diagnosis to match each problem by linking all
the history, symptoms and signs found on assessment.
1.9 Apply knowledge of basic sciences and natural progression of disease
to the patient’s presenting complaint.
1.10 Act on time critical investigations results as they arise.
1.11 Apply knowledge of basic sciences to the analysis of raw information
from investigations.
1.12 Apply understanding of indications for the following investigations,
their theoretical accuracy, principles underpinning their performance
and interpretation of formal reports to patient care:
(a) Tests for inborn errors of metabolism (urine and serum)
SEP, SDL,
(b) Tumour markers WBA, ITA, FEx
ST
(c) Histopathology
(d) Cytology
1.13 Under direct supervision, analyse results of fasting lipids
investigations.
1.14 Independently analyse and interpret results of the following
investigations
(a) 12-lead ECG patterns or patterns on ECG rhythm strip,
including:
i) Screening in asymptomatic adult patient – recognition
of normal adult ECG, artefact, paced rhythm and lead
misplacement
ii) Identification of obvious cause of chest pain/SOB,
e.g., localised ST segment elevation or depression
indicative of acute ischaemia
iii) Identification of obvious cause of syncope/
palpitations, e.g., cardiac arrest rhythms, ventricular
tachycardia or atrial tachyarrhythmia, prolonged QT
interval
iv) Identification of life-threatening electrolyte or
toxicology abnormalities, e.g., hyperkalaemia, tricyclic
anti-depressant
(b) Spirometry/peak flow meter measurement

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TS1 (c) Plain radiology images, including chest x-ray (all views), cervical
continued spine, pelvis, abdominal x-ray (all views)
(d) Laboratory investigations, including:
i) Full blood count – haemoglobin (HB), mean cell volume
(MCV), white cell count (WCC) and differential (diff),
platelet count (Plt)
ii) Blood film, including malaria thick and thin films
iii) Reticulocyte count, bleeding time
iv) INR, APTT, D-Dimer
v) Blood glucose (bedside and formal) SEP, SDL,
WBA, ITA, FEx
ST
vi) Electrolytes, urea, creatinine
vii) Creatinine kinase
viii) Calcium, magnesium, phosphate
ix) Cardiac enzymes
x) Liver function tests, amylase, lipase
xi) Paracetamol levels
xii) Urine dipstick and beta Human Chorionic Gonadotropin
(bhCG)
xiii) Microbiology culture results

TS2 Be able to:

2.1 Complete a focused clinical assessment while simultaneously looking for
evidence of time critical diagnoses.
2.2 Recognise inconsistencies within elements of the focused assessment
that require clarification.
2.3 Recognise the contribution of social and cultural complexities in clinical
assessment of history and examination.
2.4 Seek collateral history to support clinical findings in a socially and
culturally safe manner.
2.5 Formulate a provisional diagnosis to match the immediate issues.
2.6 Incorporate the concepts of likelihood and severity of disease into the
differential diagnosis, inclusive of the social determinants of health.
2.7 Incorporate investigation results into the diagnostic reasoning process.
2.8 Perform rational investigation selection after completing a patient’s
clinical assessment.
2.9 Under direct supervision, analyse the results of the following
investigations: SEP, SDL,
WBA, ITA, FEx
ST
(a) Advanced inflammatory markers (Rh factor, ANA, ANCA)
(b) Parathyroid hormones, cortisol/ACTH/Synacthen test
2.10 Independently analyse and interpret results of the following
investigations:
(a) 12-lead ECG patterns or patterns on ECG rhythm strip, including:
i) Identification of other cause of chest pain/SOB, e.g.,
ischaemia-related syndromes, pathological Q waves,
atypical ischaemic patterns, ventricular hypertrophy,
PR depression, acute right ventricular strain, ischaemia
mimics
ii) Identification of other causes of syncope/palpitations,
e.g., 1st, 2nd, 3rd degree heart block, bundle branch
blocks, fascicular blocks, Brugada syndromes, pacemaker
problems
iii) Identification of other medical problems, e.g.,
temperature, calcium, digoxin

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TS2 (b) pH testing of eye tears
continued
(c) plain radiology images, including long bones, clavicle,
scapula, patella, OPG
(d) CT images, including:
i) CT head (plain) for assessment of life-threatening
causes of abnormal neurology
ii) CT kidneys, ureters, bladder, e.g., identification of
calculus, signs of obstruction, AAA
(e) Laboratory investigations, including:
i) Blood gas analysis (arterial and venous)
SEP, SDL,
ii) Fibrinogen, fibrinogen degradation products WBA, ITA, FEx
ST
iii) Erythrocyte sedimentation rate and C-reactive protein
iv) Quantitative bHCG
v) Serum osmolality
vi) Serum lactate
vii) Thyroid function tests, iron studies, HbA1c, drug levels,
serum/RBC folate
viii) Microbiology specific antigen results (PCR), malaria
detection tests
ix) Viral serology tests (EBV, CMV, hepatitis, HIV, varicella)
x) Body fluid analysis (CSF, joint, pleural, peritoneal)

TS3 Be able to:

3.1 Adapt the focused clinical assessment to situations with a paucity of

clinical information.
3.2 Complete an accurate focused clinical assessment of an
undifferentiated patient within a limited timeframe.
3.3 Tailor a socially and culturally safe assessment style to the patient
and the situation.
3.4 Complete a focused clinical assessment of a patient to clarify the
findings of a junior clinician.
3.5 Refine the provisional diagnosis as more information comes to hand.
3.6 Create a focused investigation plan that concentrates on confirming
or excluding time critical diagnoses. SEP, SDL,
WBA, ITA, FEx
3.7 Under direct supervision, analyse results from the following ST
investigations:
(a) Cardiac exercise stress test
(b) Cardiotocography
(c) Nerve conduction studies
(d) Image from nuclear medicine or MRI, including:
i) VQ scan
ii) Bone scan
iii) MRI brain and spinal cord
iv) Echocardiogram
(e) Cholinesterase levels for toxicology monitoring

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TS3 3.8 Independently analyse and interpret results of the following

continued investigations:
(a) 12-lead ECG patterns or patterns on ECG rhythm strip,
including:
i) Screening in paediatric patient, e.g., recognition of a
normal paediatric ECG
ii) Identification of non-obvious cause of syncope/
palpitations, e.g., re-entry pathways, different types of
VT
(b) Formal respiratory function test
(c) Plain radiology images, e.g., paediatric CXR, AXR, cervical
spine, pelvis, extremities; adult small bones; paediatric
extremities; thoracolumbar spine; facial (all views); soft tissue
neck
(d) CT images including:
i) CT head (+/- contrast) for assessment of acute
important findings, e.g., mass lesion, hydrocephalus,
pneumocephalus, radiological signs of increased
intracranial pressure SEP, SDL,
WBA, ITA, FEx
ii) CT face and orbits, e.g., fracture or orbital entrapment ST
iii) CT thorax (+/- contrast) for assessment of acute
important findings, e.g., fracture, pneumothorax,
haemothorax, infiltrative process, effusion or
consolidation, major vessel aneurysm, dissection,
rupture or occlusion
iv) CT spine, e.g., fracture or disc prolapse
v) CT abdomen/pelvic, e.g., organ perforation/laceration,
mass lesion, inflammatory process, major vessel
dissection or rupture
vi) CT other bones (neck of femur, foot, ankle), e.g.,
fracture or mass lesion, disrupted anatomy
vii) CT aortogram, CTPA, e.g., massive pulmonary embolus
or obvious aortic dissection
3.9 Images obtained by a FACEM credentialled to perform ED sonography,
including cardiac arrest ECG or FELS, to assess cardiac activity during
resuscitation
3.10 Laboratory investigations, including drug levels, urine osmolality,
urinary sodium, and snake venom detection kit tests

TS4 Be able to:

4.1 Conduct a fragmented focused assessment which becomes whole

over time.
4.2 Summarise and prioritise the key issues that must be addressed
during and following the emergency encounter, considering health
literacy, and the knowledge of and access to health services, as
factors influencing community care. SEP, SDL,
WBA, ITA, FEx
ST
4.3 Adapt the technique of provision of information to the needs of the
patient and/or their family/whānau.
4.4 Justify investigation selection based on the patient’s presentation,
pre-test probability, risk-benefit ratio and resources of the local
health service.

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TS4 4.5 Under direct supervision, analyse the following investigations:

continued (a) Stress Thallium/Sestamibi scan
(b) MRI bones SEP, SDL,
WBA, ITA, FEx
(c) MRI soft tissues ST
4.6 Independently analyse and interpret results of cholinesterase levels
for toxicology monitoring.

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2.5 Analysis of Investigations

In the process of diagnosis, Emergency Medicine Physicians integrate their medical expertise with information gleaned
from focussed assessment, including observations, patient history, physical examination findings, investigation results,
and responses to therapeutic interventions. With specific regard to investigations, including those listed below,
Emergency Medicine Physicians are expected to:

+ Demonstrate understanding of indications for the investigation;

+ Demonstrate understanding of the theoretical accuracy of the investigation using knowledge of statistics;
+ Demonstrate understanding of how the investigation is undertaken, underpinned by knowledge of the basic
sciences that form the foundations of emergency medicine;
+ Perform rational test selection;
+ Identify, describe and evaluate relevant investigation findings and understand possible causes for a given result;
and
+ Incorporate the evaluation of investigation results to the refinement of a patient’s differential diagnosis and
management plan.
For the majority of the investigations listed below, and described in further detail throughout the Medical Expertise
domain of the FACEM Curriculum, Emergency Medicine Physicians are required to independently analyse and apply
findings to diagnosis and patient management, confirmed though limited supervision and supplemented by use of
references and conferral with colleagues, when necessary. The following list provides guidance to trainees, supervisors
and assessors with respect to the level of practice expected of trainees as they progress through each stage of
the FACEM Training Program. It is expected that trainees will acquire the requisite knowledge and skills to analyse
and apply investigation results under the direct supervision (S) of senior clinicians, and advance to doing so at an
independent (I) level of practice with further experience and consolidation of skills, through both direct management
of patient presentations and the discussion of cases managed by colleagues. More complex investigations are to be
analysed under the direct supervision of other suitably credentialled clinicians, or via formal reports provided by them.

The analysis of investigations is learned through the structured education program of the accredited training site
and through supervised training, and is assessed in the Primary VIVA examination, the workplace-based assessments
(WBAs), and both Fellowship examinations.

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Level of practice
S = under direct supervision
Investigations I = independently

End TS1 End TS2 End TS3 End TS4

12 lead ECG patterns or patterns on ECG rhythm strip

+ ECG: screening in asymptomatic adult patient Recognition of a
I
normal adult ECG, artefact, paced rhythm and lead misplacement
+ ECG: screening in asymptomatic paediatric patient
S I
Recognition of a normal paediatric ECG
+ ECG: identification of obvious cause of chest pain/SOB
e.g. localised ST segment elevation or depression indicative of I
acute ischaemia
+ ECG: identification of other cause of chest pain/SOB
e.g. ischemia related syndromes (Wellen’s Syndrome), pathological
Q waves, atypical ischaemic patterns, left or right ventricular S I
hypertrophy, PR depression, acute right ventricular strain,
ischaemia mimics
+ ECG: identification of obvious cause of syncope/palpitations
e.g. cardiac arrest rhythms, ventricular tachycardia or atrial I
tachyarrhythmia, prolonged QT interval
+ ECG: identification of other cause of syncope/palpitations
e.g. st, DSnd or IPrd degree heart block, bundle branch blocks, S I
fascicular blocks, Brugada syndromes, pacemaker problems-issues
+ ECG: identification of non-obvious cause of syncope/palpitations
S I
e.g. re-entry pathways, different types of VT
+ ECG: identification of life-threatening electrolyte or toxicology
abnormalities I
e.g. hyperkalemia, tricyclic anti-depressant
+ ECG: identification of other medical problems
S I
e.g. temperature, calcium, digoxin

Bedside functional investigations

+ Spirometry/ Peak Flow Meter measurement S I

+ pH testing of eye tears S I

Other functional investigations

+ Formal respiratory function test S I

+ Cardiac exercise stress test S

+ Cardiotocography (CTG) S

+ Nerve conduction studies S

Plain radiology images

+ CXR (all views) I

+ Cervical Spine I

+ Pelvis I

+ AXR (all views) I

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Level of practice
S = under direct supervision
Investigations I = independently

End TS1 End TS2 End TS3 End TS4

Plain radiology images (continued)

+ Paediatric CXR/AXR/Cervical Spine/ Pelvis S I

+ Extremities – long bones, clavicle, scapula, patella S I

+ Extremities – small bones S I

+ Paediatric extremities S I

+ Thoracolumbar Spine S I

+ OPG S I

+ Facial (all other views) S I

+ Soft tissue neck S I

+ Other plain radiology films

S I
e.g. skeletal survey, skull, bowel series

CT images
+ CT head (plain): life-threatening cause of abnormal neurology
S I
e.g. Haemorrhage, mass effect, skull fracture
+ CT head (+/- contrast): other acutely important findings
e.g. Mass lesion, hydrocephalus, pneumocephalus, radiological S
signs of increased intracranial pressure
+ CT face and orbits
S I
e.g. Fracture or orbital entrapment
+ CT thorax (+/- contrast) – acutely important findings
e.g. Fracture, pneumothorax, haemothorax, infiltrative process,
S I
effusion or consolidation, major vessel aneurysm, dissection,
rupture or occlusion
+ CT Spine
S I
e.g. Identification of fracture or disc prolapse
+ CT kidneys, ureters, bladder
S I
e.g. identification of calculus, signs of obstruction, AAA
+ CT abdomen/pelvis
e.g. Identification of organ perforation/laceration, mass lesion, S I
inflammatory process, major vessel dissection or rupture
+ CT other bones (neck of femur, foot, ankle)
S I
e.g. Identification of fracture or mass lesion, or disrupted anatomy
+ CT Aortogram, CTPA
e.g. Identification of massive pulmonary embolus or obvious aortic S I
dissection

Ultrasound

+ Cardiac arrest echocardiogram S I

+ Echocardiogram S

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Level of practice
S = under direct supervision
Investigations I = independently

End TS1 End TS2 End TS3 End TS4

Ultrasound (continued)
+ EFAST ultrasound
Identification of intraperitoneal free fluid, haemothorax, S I
pneumothorax or cardiac tamponade
+ FELS
Identification of pericardial effusion, cardiac activity, LV systolic S I
function, RV strain, gross volume assessment
+ AAA ultrasound
S I
Identification and localisation of abdominal aortic aneurysm
+ Lung ultrasound
S I
Identification of pleural/ pulmonary pathology
+ Obstetric/gynaecological ultrasound
S
e.g., assessment of intrauterine pregnancy
+ Soft tissue ultrasound
S
Presence or absence of foreign body or abscess

+ Hepatobiliary ultrasound S

+ Advanced haemodynamic assessment protocols S S

+ Doppler for DVT S

+ Doppler of carotid arteries S

+ Ultrasound for ruptured tendons and joints S

+ Renal Ultrasound S

Nuclear medicine imaging and MRI

+ VQ scan S

+ Bone Scan S

+ Stress Thallium/Sestamibi scan S

+ MRI Brain and spinal cord S

+ MRI Bones S

+ MRI Soft Tissues S

Laboratory investigations

+ Blood Gas Analysis (arterial and venous) S I

+ Full Blood Count (Hb, MCV, WCC and diff, Plt) I

+ Blood film, including malaria thick and thin films I

+ Reticulocyte count, Bleeding time I

+ INR, APTT, D-Dimer I

+ Fibrinogen, Fibrinogen degradation products S I

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Level of practice
S = under direct supervision
Investigations I = independently

End TS1 End TS2 End TS3 End TS4

Laboratory investigations (continued)

+ Blood Glucose (bedside and formal) I

+ Electrolytes, Urea, Creatinine I

+ Creatinine Kinase I

+ Calcium, Magnesium, Phosphate I

+ Erythrocyte sedimentation rate and C-reactive protein S I

+ Cardiac enzymes I

+ Quantitative beta HCG S I

+ Serum osmolality S I

+ Serum Lactate S I

+ Liver Function Tests, Amylase, Lipase I

+ Thyroid Function Tests, Iron studies, HbA1c, Drug Levels, Serum/RBC

S I
folate

+ Paracetamol levels I

+ Other drug levels S I

+ Cholinesterase levels for toxicology monitoring S I

+ Urine Dipstick and beta HCG I

+ Urine osmolality, urinary sodium S I

+ Microbiology culture results I

+ Microbiology specific antigen results (PCR), Malaria detection tests S I

+ Viral serology tests (EBV, CMV, Hepatitis, HIV, varicella) S I

+ Snake venom detection kit tests I

+ Body fluid analysis (cerebrospinal fluid, joint, pleural, peritoneal) S I

+ Fasting lipids S

+ Advanced inflammatory markers (Rh Factor, ANA, ANCA) S

+ Parathyroid hormones, cortisol/ACTH/Synacthen test S

+ Tests for inborn errors of metabolism (urine and serum) S

+ Tumour markers S

+ Histopathology S

+ Cytology S

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2.6 Ultrasound in the emergency department

By the end of the relevant stage of training, demonstrate knowledge of ultrasound imaging and apply this
understanding to practice in emergency medicine.

Training Teaching
Learning outcomes and learning Assessment
Stage
strategies

TS1 Demonstrate knowledge and understanding of:

1.1 Physics of ultrasound waves and artefacts production

1.2 Ultrasound machine controls and image optimisation
eLM, SEP,
1.3 Bio-effects, safety, infection control and machine maintenance FEx
ST, WS
1.4 Normal anatomy as viewed in ultrasound images, as pertains to FELS,
EFAST, AAA, and lung ultrasound.

TS2 Demonstrate knowledge and understanding of:

2.1 Obvious pathologies as viewed in ultrasound images.

2.2 The role of common bedside ultrasound skills used in resuscitation
assessment, including:
(a) Focused Echocardiography in Life Support (FELS)
eLM, SEP,
(b) Extended Focused Assessment with Sonography for Trauma FEx
ST, WS
(EFAST)
(c) Abdominal Aortic Aneurysm (AAA) assessment
2.3 The role of ultrasound guided procedures when resuscitating adults,
including peripheral and central venous access.

Be able to

2.4 Perform ultrasound-guided insertion of peripheral IV cannula. SEP, ST, WS WBA, FEx

TS3 Demonstrate knowledge and understanding of:

3.1 The role of bedside ultrasound used in the resuscitation assessment of

lungs in adult patients.
3.2 Advantages and disadvantages of procedural ultrasound guidance
of a needle when compared to performance based on anatomical eLM, SEP,
FEx
landmarks, including common nerve blocks and central venous access. ST, WS
3.3 The role of bedside ultrasound in paediatric emergency resuscitation.
3.4 Findings and limitations of limited and comprehensive ultrasound
assessment in emergency medicine.

Be able to

3.5 Incorporate bedside ultrasound assessment results in diagnostic

reasoning, including:
(a) First trimester ultrasound for the presence or absence of
intrauterine pregnancy
(b) Formal pregnancy/gynaecological pelvic ultrasounds
(c) Hepatobiliary ultrasound eLM, SEP, WBA, ITA,
(d) Renal ultrasound ST, WS FEx
(e) Doppler for vascular applications
(f) Ultrasound for ruptured tendons and joints
(g) Soft tissue ultrasound
3.6 Perform Focused Echocardiography in Life Support (FELS) for the
detection of cardiac activity during cardiac arrest

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Training Teaching
Learning outcomes and learning Assessment
Stage
strategies
3.7 Perform the following ultrasound-guided procedures:
TS3
(a) Central IV cannula insertion SEP, ST, WS WBA, FEx
continued
(b) Femoral nerve and fascia iliaca blocks

TS4 Demonstrate knowledge and understanding of:

4.1 Advanced applications of bedside ultrasound beyond the resuscitation

setting, including:
(a) Needle-guided procedures beyond vascular access
(b) Combining lung, FELS, AAA and EFAST scanning into eLM, SEP, WBA, ITA,
haemodynamic assessment protocols, e.g., RUSH ST, WS FEx
(c) Other disease presentations, e.g., assessment of free peritoneal
fluid to suspected ectopic or assessment of ascites, vascular
presentations, other abdominal presentations, soft tissue
pathology, obstetric and gynaecological presentations.

Be able to

4.2 Perform the following ultrasound-guided procedures, in-plane or out-

of-plane:
(a) Pleural drains
(b) Ascitic drains
(c) Joint aspirations
4.3 Perform the following ultrasound assessments:
(a) FELS (effusion, cardiac activity, LV systolic function, RV strain, eLM, SEP, WBA, ITA,
gross volume assessment) ST, WS FEx
(b) AAA (detection of aneurysm)
(c) EFAST (pneumothorax, fluid in pericardium, thorax or
peritoneum, distended bladder)
(d) Lung (lung sliding, interstitial syndrome, consolidation,
effusions, pneumothorax, pulmonary oedema)
4.4 Adjust clinical decisions based on image quality and diagnostic
performance of ultrasound.

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2.7 Treatment

By the end of the relevant stage of training, demonstrate clinical expertise in the treatment of patients in the
emergency department.

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies
TS1 Be able to:
1.1 Recognise treatments outside the scope of emergency medicine.
1.2 Create a basic treatment plan integrating the knowledge of basic
sciences, according to the patient’s provisional diagnosis. SEP, SDL, ST WBA, ITA, FEx
1.3 Synthesise clinical information to select an appropriate procedure,
as required.
TS2 Be able to:
2.1 Implement definitive treatment plans once the diagnosis is
determined.
2.2 Demonstrate individualised and family/whānau-centred care SEP, SDL, ST WBA, ITA, FEx
that considers the cultural needs of the patient when creating a
treatment plan.
TS3 Be able to:
3.1 Recognise limitations of emergency medicine care.
3.2 Recognise the barriers to provision of adequate emergency
medicine care that patients of different social and cultural
backgrounds may encounter.
SEP, SDL, ST WBA, ITA, FEx
3.3 Modify the initial treatment plan in response to newly discovered
clinical information.
3.4 Tailor the treatment to the individual patient and situation.
3.5 Safely use critical care monitoring equipment.
TS4 Be able to:
4.1 Adapt standard therapies to any patient presentation of any
complexity.
SEP, SDL, ST WBA, ITA, FEx
4.2 Rectify sub-optimal treatment plans.
4.3 Manage unforeseen complications when performing a procedure.

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2.8 Observational Medicine

By the end of the relevant stage of training, demonstrate clinical expertise in the management of patients in the
observational or short stay units in the emergency department.

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies
TS1 Be able to:
1.1 Apply understanding of basic pathophysiology of common illnesses
and injuries to patients cared for in Observational Medicine.
1.2 Recognise patients who meet criteria for admission or who require
further evaluation.
SEP, SDL, ST WBA, ITA, FEx
1.3 Ensure the required interventions are performed during the ED
admission.
1.4 Recognise and respond to a deteriorating patient and initiate initial
resuscitation.
TS2 Be able to:
2.1 Synthesise the data available to provide the correct diagnosis and
determine the urgency and appropriateness of further investigation
or therapy required.
2.2 Develop a rational plan of investigation and therapy for a specific SEP, SDL, ST WBA, ITA, FEx
admission diagnosis.
2.3 Monitor the effectiveness of interventions at timely intervals whilst
the patient is in ED.
TS3 Be able to:
3.1 Apply understanding of natural history of common illnesses and
injuries to patients cared for in Observational Medicine.
3.2 Consider alternative diagnoses and therapies for a patient under
observation and changes plan accordingly.
3.3 Recognise patients who do not respond to therapy as expected and
adjust the approach accordingly. SEP, SDL, ST WBA, ITA, FEx
3.4 Escalate care, including referral for inpatient care as required.
3.5 Manage the deteriorating patient appropriately.
3.6 Utilise available clinical and allied health resources, including
Indigenous/Aboriginal Health Liaison Officers, in management of the
patient and subsequent discharge.
TS4 Be able to:
4.1 Apply understanding of cost-effective ordering of diagnostic studies
based on the pre-test probability of disease and the likelihood of
the result altering further management to patients cared for in
Observational Medicine.
4.2 Discriminate between conflicting diagnostic results.
4.3 Apply understanding of roles, availability and capability of SEP, SDL, ST WBA, ITA, FEx
community healthcare, including services tailored to support
a patient’s social and cultural needs, to patients cared for in
Observational Medicine.
4.4 Function of chest pain units, their use, and effects on patient flow
within emergency departments.

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2.9 Documentation and Handover

By the end of the relevant stage of training, demonstrate expertise in the development and maintenance of
appropriate documentation and the conduct of clinical handover in the emergency department.

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS1 Demonstrate knowledge and understanding of:

1.1 Detail required for adequate, concise and legally sound

SEP, ST WBA, ITA, FEx
documentation in emergency medicine.

Be able to:

1.2 Use clinical notes to reflect the sequence of events during a patient
encounter.
1.3 Apply understanding of the purpose of a discharge letter and
admission documentation by recording clear discharge or admission ST WBA, ITA, FEx
orders.
1.4 Document handover of patient care.
1.5 Convey clinical information in a structured format during handover.

TS2 Be able to:

2.1 Record performance of procedures, including consent and

management of complications.
2.2 Write discharge letters that summarise important, relevant
information for community health professionals.
2.3 Extract salient points relating to the patient’s care and present these ST WBA, ITA, FEx
in a structured manner during handover.
2.4 Clearly transfer unfinished assessment and management tasks
during handover.
2.5 Clarify outstanding tasks when receiving a handover.

TS3 Be able to:

3.1 Produce succinct patient records and convey clinical reasoning

when documenting a patient encounter.
3.2 Ensure clear documentation of the purpose and findings of a
requested patient review. ST WBA, ITA, FEx
3.3 Record advanced care orders, limitations of treatment and their
reasons.
3.4 Reassess and review management of the handover patient.

TS4 Be able to:

4.1 Write a concise and accurate summary of key issues in any patient’s
care.
4.2 Ensure that outstanding tasks handed over are relevant to the
ST WBA, ITA, FEx
current emergency encounter.
4.3 Clarify and focus the clinical reasoning of the clinician providing
information during handover.

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2.10 Patient Disposition

By the end of the relevant stage of training, demonstrate clinical expertise in the management of patient
disposition in the emergency department.

Teaching
Training
Learning outcomes & Learning Assessment
Stages
Strategies
TS1 Be able to:
1.1 Create a clear clinically and culturally safe discharge plan for a
patient.
1.2 Provide clear instructions for the patient/carer on discharge and
ensure comprehension, including the likely progression of their
SEP, SDL, ST WBA, ITA, FEx
clinical course, and reasons to return for review.
1.3 Provide the necessary discharge documentation.
1.4 Write an admission plan which addresses immediate and ongoing
interim care for a stable patient.
TS2 Be able to:
2.1 Predict and facilitate ongoing treatment after the emergency
encounter.
2.2 Identify risk factors associated with patients/carers wanting to
cease their emergency care prematurely. SEP, SDL, ST WBA, ITA, FEx
2.3 Escort a stable patient within a hospital to a high dependency unit.
2.4 Clearly define the transition between emergency care and inpatient
care in the patient journey.
TS3 Be able to:
3.1 Identify the vulnerable patient who will require further support on
discharge.
3.2 Implement strategies to prevent a patient ceasing their emergency
care prematurely.
3.3 Transfer a critically unwell patient for further investigation and/or
definitive care within a hospital. SEP, SDL, ST WBA, ITA, FEx
3.4 Prepare a stable patient for transfer to another hospital for
definitive care.
3.5 Decide and rationalise an admission of a patient to a specific
inpatient unit based on a provisional diagnosis and expected
clinical course.
TS4 Be able to:
4.1 Specify the resources that will be required to address ongoing post-
disposition needs, with consideration of social and cultural factors.
4.2 Decide which delayed results prompt a recall of a patient to the
emergency department for assessment.
4.3 Create a plan that matches the level of risk for a patient who has
ceased their emergency care prematurely.
4.4 Prepare a critically unwell patient for transfer to another hospital SEP, SDL, ST WBA, ITA, FEx
for definitive care.
4.5 Arrange the transfer of a patient to another hospital.
4.6 Perform an emergency escort of an unstable patient for definitive
management when required.
4.7 Confirm and enhance admission plans created by more junior
clinicians working within the emergency department.

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3. Clinical Management in Emergency Medicine

Integrate understanding of foundations of emergency medicine with principles of practice in the focused
assessment, diagnosis and management of undifferentiated clinical presentations.

3.1 Cardiovascular Presentations

By the end of the relevant stage of training, demonstrate knowledge and understanding of cardiovascular
presentations and apply this to the management of patients with these presentations in the emergency
department.

Teaching
Training
Learning outcomes & Learning Assessment
Stages
Strategies

TS1 Demonstrate knowledge and understanding of:

1.1 Aetiology and pathophysiology of:

(a) Congestive cardiac failure
(b) Valvular disorders, including aortic, mitral, tricuspid
and pulmonary, and conditions associated with valvular
disorders, including rheumatic heart disease
(c) Disorders of the myocardium, including cardiomyopathy,
aneurysm, atrial septal defect, ventricular septal defect,
dextrocardia
(d) Disorders of the pericardium, including acute pericarditis,
constrictive pericarditis, pericardial effusion, pericardial
tamponade, pericardiocentesis
(e) Cardiogenic shock
(f) Hypertension
(g) Disorders of peripheral vasculature, including peripheral
ischaemia, deep vein thrombosis, pulmonary embolism,
mesenteric ischaemia
(h) Endocarditis
(i) Tumours
SEP, SDL, ST WBA, ITA, FEx
(j) Congenital heart disease, including cyanotic heart disease,
rheumatic fever
(k) Arterial and venous occlusions
(l) Intestinal ischaemia
(m) Thoracic dissection
(n) Intra-abdominal aneurysms
(o) Aortic aneurysms, aortic dissection
(p) Mycotic aneurysms
(q) Intra-arterial drug injection
(r) Acute coronary syndromes
1.2 Pathophysiology of arrhythmia, including:
(a) Bradycardias, including sinus bradycardia, heart block
(b) Tachycardias, including narrow complex regular, narrow
complex irregular, wide complex regular, wide complex
irregular, torsade des pointes, ventricular fibrillation
(c) Ectopy, narrow and wide complex
1.3 Accessory pathways, including Wolff-Parkinson-White syndrome.

Be able to:

1.4 Interpret symptoms and clinical signs of cardiovascular disorders.

1.5 Generate a diagnosis, provide initial targeted treatment, and plan SEP, SDL, ST WBA, ITA, FEx
further investigations for patients presenting with cardiovascular
disorders.

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Teaching
Training
Learning outcomes & Learning Assessment
Stages
Strategies

TS2 Demonstrate knowledge and understanding of:

2.1 Aetiology and pathophysiology of acute coronary syndromes,

including:
(a) Right ventricular myocardial infarction
(b) Thrombolysis myocardial infarction SEP, SDL, ST WBA, ITA, FEx
(c) Left ventricular failure and cardiogenic shock in the setting
of myocardial infarction
(d) ST elevation in the absence of myocardial infarction

Be able to:

2.2 Generate a differential diagnosis, plan of management and

SEP, SDL, ST WBA, ITA, FEx
disposition for patients with syncope.

TS3 Demonstrate knowledge and understanding of:

3.1 Prehospital management of acute coronary syndromes. Describe

pros and cons of acute coronary syndrome pathways.
3.2 ANZCOR guidelines for the management of arrhythmias.
3.3 Implantable cardiac devices, including pacemakers and
defibrillators, temporary pacing wires, and associated complications
of their use.
SEP, SDL, ST WBA, ITA, FEx
3.4 Principles of external and internal emergent cardiac pacing
including indications, contraindications and management of
complications.
3.5 Principles of cardiac transplantation, including complications
of transplants and increased risk of infection due to
immunosuppression.

Be able to:

3.6 Interpret a complex ECG in the setting of acute coronary syndromes.

3.7 Interpret relevant investigations as per the investigations list.
3.8 Perform procedures for the management of respiratory SEP, SDL, ST WBA, ITA, FEx
presentations, including:
3.9 External emergent cardiac pacing.

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3.2 Respiratory Presentations

By the end of the relevant stage of training, demonstrate knowledge and understanding of respiratory
presentations and apply this to the management of patients with these presentations in the emergency
department.

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies
TS1 Demonstrate knowledge and understanding of:
1.1 Aetiology and pathophysiology of, including:
(a) Respiratory failure
(b) Upper airway obstruction
(c) Infectious diseases, including croup, bronchitis, pneumonia,
empyema
(d) Aspiration
(e) Acute lung injury, respiratory distress syndrome
(f) Asthma
(g) Pneumothorax
(h) Pneumomediastinum
(i) Chronic obstructive pulmonary disease
SEP, SDL, ST WBA, ITA, FEx
(j) Pleural effusions
(k) Haemoptysis
(l) Cavitating lung lesions
(m) Isolated ‘coin’ lesions on chestw x-ray
(n) Disorders of the chest wall
(o) Disorders of the mediastinum, including mediastinitis,
mediastinal masses
(p) Sleep apnoea
(q) Neoplastic disorders
(r) Congenital disorders, including bronchopulmonary
dysplasia, cystic fibrosis

Be able to:
1.2 Take a history and perform a targeted examination of a patient with
a suspected respiratory illness.
1.3 Interpret symptoms and clinical signs of respiratory illness.
SEP, SDL, ST WBA, ITA, FEx
1.4 Generate a differential diagnosis, plan of management and
disposition for patients with respiratory illness.
1.5 Perform intercostal catheter insertion
TS2 Demonstrate knowledge and understanding of:

2.1 Respiratory effects of obesity. SEP, SDL, ST FEx

TS3 Demonstrate knowledge and understanding of:

3.1 Principles of lung transplantation, including complications
of transplants and increased risk of infection due to SEP, SDL, ST FEx
immunosuppression.
Be able to:

3.2 Perform needle thoracocentesis for aspiration of pleural fluid. SEP, SDL, ST WBA, ITA, FEx

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3.3 Gastrointestinal Presentations

Demonstrate knowledge and understanding of gastrointestinal presentations and apply this to the management
of patients with these presentations in the emergency department.

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS1 Demonstrate knowledge and understanding of:

1.1 Aetiology and pathophysiology of gastrointestinal bleeding, including:
(a) Oesophageal varices
(b) Peptic ulceration
(c) Angiodysplasia of the colon
1.2 Pharmacological agents used in the management of gastrointestinal
bleeding.
1.3 Aetiology and pathophysiology of oesophageal disorders, including:
(a) Infectious disorders
(b) Oesophagitis
(c) Gastroesophageal reflux
(d) Neoplastic disorders
1.4 Aetiology and pathophysiology of problems of the bowel, including:
(a) Inflammatory bowel disease
(b) Irritable bowel syndrome
(c) Infectious disorders and gastroenteritis
(d) Bowel obstruction, including:
(e) Post-surgical adhesions
(f) Malrotation
(g) Volvulus
(h) Congenital pyloric stenosis
(i) Intussusception
SEP, SDL, ST WBA, ITA, FEx
(j) Diverticular disease
(k) Meckel’s diverticulum
(l) Acute appendicitis
(m) Ischaemic colitis
(n) Constipation
1.5 Aetiology and pathophysiology of other abdominal presentations,
including:
(a) Peritoneal adhesions
(b) Hernias
(c) Tumours
1.6 Aetiology and pathophysiology of gastritis and gastroenteritis.
1.7 Aetiology and pathophysiology of the hepatobiliary system and
pancreatic disorders including:
(a) Hepatic failure
(b) Hepatitis
(c) Infectious disorders of the liver
(d) Alcoholic liver disease
(e) Hepato-renal syndrome
(f) Portal hypertension
(g) Cholelithiasis, cholecystitis, cholangitis
(h) Pancreatitis

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Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies
TS1
Be able to:
continued
1.8 Take a history and perform a targeted examination of a patient with
a suspected gastrointestinal illness.
1.9 Interpret symptoms and clinical signs of gastrointestinal Illness.
1.10 Interpret relevant investigations as per the investigations list. SEP, SDL, ST WBA, ITA, FEx
1.11 Generate a differential diagnosis and plan of management for
patients with gastrointestinal illness.
1.12 Perform insertion of a nasogastric tube.
TS2 Demonstrate knowledge and understanding of:
2.1 Aetiology and pathophysiology of anorectal presentations, including:
(a) Haemorrhoids
(b) Perianal haematoma
(c) Anal fissure
(d) Anorectal abscesses
(e) Pilonidal disease
(f) Rectal bleeding
(g) Rectal prolapse SEP, SDL, ST WBA, ITA, FEx
(h) Radiation proctitis
(i) Rectal foreign bodies
2.2 Aetiology and pathophysiology of other abdominal presentations,
including:
(a) Peritonitis
(b) Retroperitoneal haematoma
(c) Intraabdominal/retroperitoneal abscesses
TS3 Demonstrate knowledge and understanding of:
3.1 Indications for urgent gastroscopy.
3.2 Techniques used with gastroscopy to control haemorrhage, including
balloon tamponade of gastro-oesophageal varices.
3.3 Aetiology and pathophysiology of other abdominal presentations,
including: SEP, SDL, ST WBA, ITA, FEx
(a) Motor abnormalities
(b) Mallory-Weiss syndrome
(c) Stricture and stenosis
(d) Tracheo-oesophageal fistula

Be able to:

3.4 Perform procedures for the management of gastrointestinal

presentations, including:
SEP, SDL, ST WBA, ITA, FEx
(a) Abdominal paracentesis
(b) Incision and drainage of thrombosed external haemorrhoid

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3.4 Neurological Presentations

By the end of the relevant stage of training, demonstrate knowledge and understanding of neurological
presentations and apply this to the management of patients with these presentations in the emergency
department.

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS1 Demonstrate knowledge and understanding of:

1.1 Aetiology and pathophysiology of neurological diseases caused by

infectious agents.
1.2 Function of stroke units, their use, and effects on patient flow in
SEP, SDL, ST WBA, ITA, FEx
emergency departments.
1.3 Aetiology and pathophysiology of cerebrovascular accidents (CVA).
1.4 Aetiology and pathophysiology of seizures and status epilepticus.

Be able to:

1.5 Take a history and perform a targeted examination of a patient with

a suspected neurological illness.
1.6 Take a history and perform a targeted examination of a patient with
SEP, SDL, ST WBA, ITA, FEx
ataxia and gait disturbances.
1.7 Interpret symptoms and clinical signs of neurological illness.
1.8 Interpret relevant investigations as per the investigations list.

TS2 Demonstrate knowledge and understanding of:

2.1 Aetiology and pathophysiology of altered mental state, including

delirium and coma. SEP, SDL, ST WBA, ITA, FEx
2.2 Aetiology and pathophysiology of headache and facial pain.

Be able to:

2.3 Perform lumbar puncture and measure CSF opening pressure. SEP, SDL, ST WBA, ITA, FEx

TS3 Demonstrate knowledge and understanding of:

3.1 Aetiology and pathophysiology of altered mental state, including:

(a) Dementia
(b) Memory disorders
3.2 Aetiology and pathophysiology of:
(a) Guillain-Barré syndrome
(b) Multiple sclerosis
(c) Myasthenia gravis and Eaton-Lambert syndrome
(d) Motor neurone disease
(e) Peripheral neuropathy SEP, SDL, ST WBA, ITA, FEx
(f) Peripheral nerve lesions
(g) Brachial plexus syndrome
(h) Myopathy
(i) Periodic paralysis
(j) Parkinson’s disease
(k) Hydrocephalus
(l) Disorders of the spinal cord
(m) Paraneoplastic disorders of the CNS and PNS

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Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies
TS3 3.3 Aetiology and pathophysiology of cranial nerve disorders.
continued
3.4 Aetiology and pathophysiology of spinal cord injury, including
medical problems in the spinally injured patient
3.5 Aetiology and pathophysiology of neurosurgical presentations,
including:
(a) Intracranial aneurysms
(b) AV malformations SEP, SDL, ST WBA, ITA, FEx
(c) Subarachnoid haemorrhage
(d) Cerebral tumours
(e) Shunt complications
(f) Elevated intracranial pressure
(g) Intervertebral disc disease
(h) Spinal stenosis including cauda equina syndrome

Be able to:

3.6 Manage dystonic reactions.

3.7 Generate a differential diagnosis, plan of management and SEP, SDL, ST WBA, ITA, FEx
disposition for patients with neurological illness.

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3.5 Ophthalmological Presentations

By the end of the relevant stage of training, demonstrate knowledge and understanding of ophthalmological
presentations and apply this to the management of patients with these presentations in the emergency
department.

Teaching
Training
Learning outcomes & Learning Assessment
Stages
Strategies
TS1 Be able to:
1.1 Take a history and perform a targeted examination of a patient with
a disorder of the eye, including the red eye, painful eye and sudden
visual loss. SEP, SDL, ST WBA, ITA, FEx
1.2 Perform direct ophthalmoscopy.
1.3 Perform eye irrigation.
TS2 Demonstrate knowledge and understanding of:
2.1 Aetiology and pathophysiology of eye presentations, including:
(a) Blepharitis, dacryocystitis, conjunctivitis
(b) Corneal abrasions, corneal ulcers, keratitis
(c) Foreign bodies: conjunctival, corneal
(d) Spontaneous subconjunctival haemorrhage
(e) Amblyopia
(f) Herpes simplex, herpes zoster SEP, SDL, ST WBA, ITA, FEx
(g) Ocular burns: caustic, flash, thermal
(h) Glaucoma, uveitis
(i) Retrobulbar haemorrhage
(j) Orbital, pre-orbital cellulitis, endophthalmitis
(k) Blunt and penetrating ocular trauma
(l) Giant cell arteritis

Be able to:
2.2 Measure intraocular pressure.
2.3 Use fluorescence in removal of corneal foreign body.
SEP, SDL, ST WBA, ITA, FEx
2.4 Perform a slit lamp examination.
2.5 Apply an eye pad or shield.
TS3 Demonstrate knowledge and understanding of:

3.1 Principles of performing a lateral canthotomy. SEP, SDL, ST FEx

Be able to:
3.2 Generate a differential diagnosis and plan of management for patients
with eye disorders, including:
(a) Uveitis
(b) Retinal detachment, vitreous and retina haemorrhages, retinal SEP, SDL, ST WBA, ITA, FEx
vascular occlusions, optic neuritis
3.3 Interpret symptoms and clinical signs of eye disorders.
3.4 Interpret relevant investigations as per the investigations list.
TS4 Be able to:

4.1 Perform a lateral canthotomy. SEP, SDL, ST ITA, FEx

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3.6 Otolaryngologic Presentations

By the end of the relevant stage of training, demonstrate knowledge and understanding of ear, nose and
throat presentations and apply this to the management of patients with these presentations in the emergency
department.

Teaching
Training
Learning outcomes & Learning Assessment
Stages
Strategies

TS1 Demonstrate knowledge and understanding of:

1.1 Aetiology and pathophysiology of ear presentations, including:

(a) Otalgia
(b) Otitis media, otitis externa
(c) Cholesteatoma
(d) Perforated tympanic membrane
(e) Sudden sensorineural hearing loss
(f) Chondritis/perichondritis
(g) Mastoiditis
(h) Labyrinthitis, vestibular neuronitis
(i) Meniere’s disease
(j) Benign paroxysmal positional vertigo SEP, SDL, ST WBA, ITA, FEx
1.2 Aetiology and pathophysiology of epistaxis and sinusitis.
1.3 Aetiology and pathophysiology of throat and oropharynx
presentations, including:
(a) Acute infections
(b) Supraglottitis, epiglottitis
(c) Abscesses
(d) Post-tonsillectomy bleed
1.4 Role and use of following equipment in the assessment of
otolaryngologic and ophthalmologic presentations:
(a) Otoscope
(b) Pneumatic endoscope

Be able to:

1.5 Take a history and perform a targeted examination of a patient with

a suspected disorder of the ear, nose or throat, including the use of
otoscope and insertion of nasal speculum.
1.6 Interpret symptoms and clinical signs of ear, nose and throat illness,
with consideration for public health implications and different SEP, SDL, ST WBA, ITA, FEx
management strategies in specific populations, such as Aboriginal,
Torres Strait Islander, Māori and Pasifika patients.
1.7 Generate a differential diagnosis, treatment plan and disposition for
patients with simple ear, nose and throat illness.

TS2 Be able to:

2.1 Perform aural toilet.

2.2 Insert an ear wick.
2.3 Collect a nasopharyngeal specimen to test for infection.
2.4 Remove foreign bodies from the nose, ear, upper airway and SEP, SDL, ST WBA, ITA, FEx
pharynx.
2.5 Perform Epley’s manoeuvre.
2.6 Manage epistaxis using anterior packing, cautery, posterior packing
and balloon placement, as appropriate.

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Teaching
Training
Learning outcomes & Learning Assessment
Stages
Strategies

TS3 Demonstrate knowledge and understanding of:

3.1 Indications, contraindications and complications of drainage of a

SEP, SDL, ST WBA, ITA, FEx
peritonsillar abscess.

Be able to:

3.2 Generate a differential diagnosis, treatment plan and disposition for

SEP, SDL, ST WBA, ITA, FEx
patients with complex ear, nose and throat illness.

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3.7 Acute Psychiatric and Addiction Related Presentations

By the end of the relevant stage of training, demonstrate knowledge of principles of acute psychiatric and
behaviourally disturbed patients and application of understanding to practice in emergency medicine.
Furthermore, demonstrate knowledge of the impact of historical and current social and cultural inequities on the
mental health of specific populations, and apply this understanding to the provision of socially and culturally
safe emergency medicine care.

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS1 Demonstrate knowledge and understanding of:

1.1 Principles of assessment and management of psychiatric

presentations in the ED, including:
(a) Triage, initial assessment and de-escalation
(b) Appropriate psychiatric assessment area
(c) Role of hospital and community based mental health
clinicians and services
SEP, SDL, ST WBA, ITA, FEx
1.2 Acute mental health services available in the ED.
1.3 Use of regional mental health legislation relevant to emergency
medicine practice.
1.4 Impact of historical and socio-economic factors, including the
effects of colonisation, that increase the risk of addiction and
involvement with the mental health and justice system.

Be able to:

1.5 Undertake a mental state examination and risk assessment for the
following, and communicate findings to the team:
(a) Self-harm
(b) Suicide SEP, SDL, ST WBA, ITA, FEx
(c) Violence
(d) Unsafe discharge from ED against medical advice
1.6 Undertake an assessment of cognitive function.

TS2 Demonstrate knowledge and understanding of:

2.1 Psychiatric presentations in the ED, including:

(a) Deliberate self-harm
(b) Depression
(c) Anxiety disorders
(d) Psychoses
(e) Personality disorder
(f) Pain disorder
(g) Somatisation disorder
(h) Munchausen’s by proxy SEP, SDL, ST WBA, ITA, FEx

2.2 Principles of management of a behaviourally disturbed patient,

including methods of physical and chemical restraint.
2.3 Minimum standards of monitoring sedated behaviourally disturbed
patients.
2.4 The influence of organic brain syndromes on acute psychiatric
illness presentations, treatment, and disposition.
2.5 Issues surrounding alcohol and/or drug use in the workplace as
they relate to workplace occupational health and safety legislation.

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Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies
TS2
continued Be able to:

2.6 Generate a differential diagnosis and plan of management for

patients with acute psychiatric and behavioural illness.
2.7 Verbally de-escalate the culturally diverse patient in a culturally
safe manner.
2.8 Safely sedate the acute behaviourally disturbed patient and initiate
appropriate monitoring.
2.9 Recognise patients who would benefit from cultural support,
including the needs of Aboriginal and Torres Strait Islander peoples
and Māori, and refer to appropriate services.
2.10 Identify and coordinate the management of comorbid medical and
psychiatric conditions, including:
(a) Substance misuse
(b) Self-harm and suicide risk
(c) Depression and anxiety
(d) Delirium/dementia SEP, SDL, ST WBA, ITA, FEx
2.11 Appropriately apply physical restraint to the behaviourally disturbed
patient.
2.12 Ensure medical investigations are undertaken before patients are
transferred to inpatient psychiatric unit to reduce risk of adverse
outcomes for patients with mental health presentations.
2.13 Facilitate early intervention for psychosis from the ED to pre-empt
crisis presentations.
2.14 Identify risks of transporting a behaviourally disturbed patient and
strategies to mitigate these.
2.15 Apply processes related to involuntary treatment as per the mental
health act in the relevant jurisdiction
2.16 Integrate available mental health services.
2.17 Apply the relevant regional mental health legislation, as
appropriate.

TS3 Be able to:

3.1 Lead a team to provide acute treatment for a behaviourally

disturbed patient.
3.2 Diagnose, manage and determine risks from acute withdrawal,
SEP, SDL, ST WBA, ITA, FEx
intoxication and dependence.
3.3 Appropriately package the behaviourally disturbed patient for
urgent transport.

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3.8 Toxicological and Environmental Emergency Presentations

By the end of the relevant stage of training, demonstrate knowledge of principles of toxicology, toxinology and
environmental presentations and application of understanding to practice in emergency medicine.
Teaching
Training
Learning outcomes & Learning Assessment
Stages
Strategies

TS1 Demonstrate knowledge and understanding of:

1.1 Aetiology and pathophysiology of poisoning, drug overdose and

envenomation.
1.2 Aetiology and pathophysiology of hyperthermia and hypothermia
1.3 Aetiology and pathophysiology of diving-related illness
1.4 Principles of assessment of toxicological presentations in the ED,
including:
(a) Triage and initial assessment
(b) General approach to assessment
(c) Risk assessment
(d) History (dose, drug, timing, symptoms, patient factors)
(e) Examination
(f) Investigations (ECG: sodium channel blockade, QT
prolongation)
(g) Role of toxicologists
(h) Common presentations (e.g. paracetamol, quetiapine, SSRI)
1.5 Principles of assessment of environmental presentations in the ED,
including:
(a) Triage and initial assessment
(b) General approach to assessment
PEx(W)
(c) Risk assessment SEP, SDL, ST PEx (VIVA)
(d) History WBA, ITA, FEx
(e) Examination
(f) Investigations
1.6 Principles of management of toxicological presentations including:
(a) Prehospital care
(b) General approach to management
(c) Indications for decontamination
(d) Indications for enhanced elimination
(e) Indications for antidotes
1.7 Principles of management of environmental presentations including:
1.8 Prehospital care
1.9 General approach to management
1.10 Indications for passive or active warming
1.11 Indications for rapid cooling
1.12 Indications for decompression
1.13 Role of poison centres in the management and prevention of
poisoning.
1.14 Principles of chemical dependency and substance abuse, including
drug tolerance and drug withdrawal.

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Teaching
Training
Learning outcomes & Learning Assessment
Stages
Strategies
TS1
continued Be able to:
1.15 Take a history, perform a targeted examination and risk assessment
of a poisoned patient, including agent, dose, time of ingestion,
clinical features and patient factors.
1.16 Interpret symptoms and clinical signs of poisoning.
1.17 Identify the underlying cause of the presentation, including SEP, SDL, ST WBA, ITA, FEx
distinguishing toxidromes for poisoning, drug overdose and
envenomation.
1.18 Safely and appropriately apply pressure immobilization bandage,
including use of splinting.

TS2 Demonstrate knowledge and understanding of:

2.1 Medicolegal considerations in the assessment and management of

toxicological presentations, including:
(a) Use of restraints, physical and chemical
(b) Transport of the patient under a section or treatment order
(c) Paediatric patients
(d) Management of patient escorts
2.2 Psychiatric and social aspects of overdose. SEP, SDL, ST WBA, ITA, FEx

2.3 Principles of assessment and management of toxicological

presentations in the ED, including:
(a) Paediatric patients presenting with suspected ingestion of
toxic substances or items, including batteries
(b) Drugs of abuse (stimulants, opioids, sedatives [eg GHB,
benzodiazepines]) and withdrawal

Be able to:

2.4 Identify the appropriate antidote or antivenom.

2.5 Identify patients requiring decontamination.
2.6 Identify patients requiring hyperbaric treatment of diving related
illnesses including decompression sickness
SEP, SDL, ST WBA, ITA, FEx
2.7 Identify patients requiring warming or cooling, and initiate basic
warming and cooling techniques, including external methods and
administration of IV fluids.
2.8 Provide appropriate treatment for a toxicological presentation.

TS3 Demonstrate knowledge and understanding of:

3.1 Principles of assessment and management of toxicological

presentations in the ED, including:
(a) Life threatening presentations (e.g., calcium channel
blockers, beta blockers, TCA, toxic alcohols)
(b) Envenomation (snake, spider, marine)
(c) Poisonous fungi and plants (ingestion, exposure)
SEP, SDL, ST WBA, ITA, FEx
3.2 Principles of industrial toxicology, including presentations associated
with exposure to and/or ingestion of:
(a) Toxic metals and metal fumes
(b) Toxic gases
(c) Toxic liquids
(d) Pesticides, herbicides and rodenticides

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Teaching
Training
Learning outcomes & Learning Assessment
Stages
Strategies
TS3 3.3 Aetiology and pathophysiology of exposure syndromes of chemical,
continued biological and radiological agents, with specific regard to:
(a) Dose-response relationships and factors affecting toxicity
SEP, SDL, ST WBA, ITA, FEx
(b) Latency
3.4 Sources of toxin and chemical, biological and radiological agent
advice.

Be able to:

3.5 Lead a team to resuscitate a patient with:

(a) Toxicological presentation
(b) Hypothermia or hyperthermia, using advanced warming and
cooling techniques.
SEP, SDL, ST WBA, ITA, FEx
(c) Decompression illness
3.6 Initiate specific decontamination measures, including gastric
decontamination and whole bowel irrigation.
3.7 Appropriately package the patient for transport as required.

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3.9 Endocrinological Presentations

By the end of the relevant stage of training, demonstrate knowledge and understanding of endocrinological
presentations and apply this to the management of patients with these presentations in the emergency
department.

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS1 Demonstrate knowledge and understanding of:

1.1 Aetiology and pathophysiology of the endocrine system, including:

(a) Disorders of glucose metabolism
PEx(W),
(b) Alcoholic ketoacidosis
SEP, SDL, ST PEx (VIVA),
(c) Adrenal disorders WBA, ITA, FEx
(d) Thyroid disorders
(e) Pituitary disorders

Be able to:

1.2 Take a history and perform a targeted examination of a patient with a

suspected endocrine disorder. PEx(W),
SEP, SDL, ST PEx (VIVA),
1.3 Interpret symptoms and clinical signs of endocrine disorders WBA, ITA, FEx
1.4 Interpret relevant investigations as per the investigations list.

TS3 Be able to:

3.1 Generate a differential diagnosis, plan of management and

SEP, SDL, ST WBA, ITA, FEx
disposition for patients with endocrine disorders

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3.10 Haematological Presentations

By the end of the relevant stage of training, demonstrate knowledge and understanding of haematological
presentations and apply this to the management of patients with these presentations in the emergency
department.

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS1 Demonstrate knowledge and understanding of:

1.5 Aetiology and pathophysiology of the haematological system,

including:
(a) Anaemia
(b) Abnormal haemoglobins PEx(W),
SEP, SDL, ST PEx (VIVA),
(c) Disorders of haemostasis and coagulation WBA, ITA, FEx
(d) Neutropenia
(e) Platelet disorders
(f) Haematological malignancy

Be able to:

1.6 Take a history and perform a targeted examination of a patient with a

suspected disorder of the haematological system.
1.7 Interpret symptoms and clinical signs of haematological disorders. PEx(W),
SEP, SDL, ST PEx (VIVA),
1.8 Interpret relevant investigations as per the investigations list. WBA, ITA, FEx
1.9 Generate a differential diagnosis, plan of management and
disposition for patients with haematological disorders.

TS2 Demonstrate knowledge and understanding of:

2.1 Indications, contraindications, adverse reactions, consent and ethical SEP, SDL, ST,
WBA, ITA, FEx
use of blood transfusions and component therapy. eLM

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3.11 Oncological Presentations

By the end of the relevant stage of training, demonstrate knowledge and understanding of oncological
presentations and apply this to the management of patients with these presentations in the emergency
department.

Teaching
Training
Learning outcomes & Learning Assessment
Stages
Strategies

TS1 Demonstrate knowledge and understanding of:

PEx(W),
1.1 Malignancies specific to organ systems. SEP, SDL, ST PEx (VIVA),
WBA, ITA, FEx

Be able to:

1.2 Take a history and perform a targeted examination of a patient with a

suspected malignancy.
1.3 Interpret symptoms and clinical signs of malignancy. PEx(W),
SEP, SDL, ST PEx (VIVA),
1.4 Interpret relevant investigations as per the investigations list. WBA, ITA, FEx
1.5 Generate a differential diagnosis, plan of management and
disposition for patients with a suspected malignancy.

TS3 Demonstrate knowledge and understanding of:

3.1 Culturally diverse beliefs surrounding health, illness and dying,

with respect to culturally specific treatments and wishes to decline
treatment specific to patients with oncological presentations.
3.2 Culturally diverse expectations for the role of family/whānau in
discussions about treatment and outcomes.
3.3 Acute complications related to local tumour involvement, including:
(a) Acute spinal cord compression
(b) Upper airway obstruction
(c) Malignant pericardial effusion
(d) Superior vena cava syndrome
(e) Pancoast’s syndrome SEP, SDL, ST WBA, ITA, FEx
(f) Hyperviscosity syndrome
3.4 Implications related to myelosuppression, including:
(a) Febrile neutropenia
(b) Immunosuppression and opportunistic infections
(c) Thrombocytopaenia and haemorrhage
3.5 Principles of paraneoplastic syndromes, including:
(a) Undiagnosed malignancy
(b) Hypercalcaemia and syndrome of inappropriate antidiuretic
hormone secretion (SIADH) in patients with known
malignancy

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3.12 Renal and Urogenital Presentations

By the end of the relevant stage of training, demonstrate knowledge and understanding of renal and urogenital
presentations and apply this to the management of patients with these presentations in the emergency
department.

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS1 Demonstrate knowledge and understanding of:

1.1 Aetiology and pathophysiology of renal presentations, including:

(a) Pyuria
(b) Infectious disorders
(c) Acute renal failure
(d) Chronic renal failure
(e) Hyperkalaemia in renal failure
(f) Complications of renal dialysis
(g) Haemolytic uremic syndrome
(h) Rhabdomyolysis
(i) Polycystic kidney disease
1.2 Aetiology and pathophysiology of urogenital presentations, including:
(a) Urinary tract infection
PEx(W),
(b) Cystitis
SEP, SDL, ST PEx (VIVA),
(c) Urethritis WBA, ITA, FEx
(d) Ureteric calculi
(e) Urinary retention
(f) Obstructive uropathy
(g) Vesico-ureteric reflux
(h) Haematuria
(i) Tumours
1.3 Disorders of the male reproductive tract, including:
(a) Acute scrotum
(b) Prostatitis
(c) Prostatic hypertrophy
(d) Phimosis/paraphimosis/balanitis
(e) Priapism

Be able to:

1.4 Take a history and perform a targeted examination of a patient with a

suspected disorder of the renal or genitourinary system.
1.5 Interpret symptoms and clinical signs of renal and genitourinary
disorders.
1.6 Interpret relevant investigations as per the investigations list. PEx(W),
including urine dipstick results, urine microscopy and culture. SEP, SDL, ST PEx (VIVA),
1.7 Generate a differential diagnosis, plan of management and WBA, ITA, FEx
disposition for patients with a suspected disorder of the renal or
genitourinary system.
1.8 Perform procedures for the management of renal and urogenital
presentations, including insertion of urethral catheter.

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Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS3 Demonstrate knowledge and understanding of:

3.1 Principles of renal transplantation, including complications

of transplants and increased risk of infection due to SEP, SDL, ST WBA, ITA, FEx
immunosuppression.

TS4 Demonstrate knowledge and understanding of:

3.2 Complex procedures for the management of renal and urogenital

SEP, SDL, ST WBA, ITA, FEx
presentations, such as the insertion of suprapubic catheters.

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3.13 Rheumatological Presentations

By the end of the relevant stage of training, demonstrate knowledge and understanding of rheumatological
presentations and apply this to the management of patients with these presentations in the emergency
department.

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS1 Demonstrate knowledge and understanding of:

1.1 Aetiology and pathophysiology of disorders of the rheumatological

system, including:
PEx(W),
(a) Arthropathies – crystal, inflammatory and degenerative
SEP, SDL, ST PEx (VIVA),
(b) Joint infections WBA, ITA, FEx
(c) Systemic complications of rheumatological disease and its
treatment

Be able to:
PEx(W),
1.2 Take a history and perform a targeted examination of a patient with a
SEP, SDL, ST PEx (VIVA),
suspected rheumatological illness. WBA, ITA, FEx

TS2 Demonstrate knowledge and understanding of:

2.1 Indications, contraindications and complications of arthrocentesis

SEP, SDL, ST WBA, ITA, FEx
and associated therapies.

Be able to:

2.2 Interpret symptoms and clinical signs of rheumatological illness.

2.3 Interpret relevant investigations as per the investigations list.
2.4 Generate a differential diagnosis, plan of management and SEP, SDL, ST WBA, ITA, FEx
disposition for patients with rheumatological illness.
2.5 Perform knee arthrocentesis.

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3.14 Dermatological Presentations

By the end of the relevant stage of training, demonstrate knowledge and understanding of dermatological
presentations and apply this to the management of patients with these presentations in the emergency
department.

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS1 Be able to:

PEx(W),
1.1 Take a history and perform a targeted examination of a patient with a
SEP, SDL, ST PEx (VIVA),
dermatological illness. WBA, ITA, FEx

TS2 Demonstrate knowledge and understanding of:

2.1 Aetiology and pathophysiology of disorders of the dermatological

system, including:
(a) Life threatening presentations: toxic epidermal necrolysis,
Stevens-Johnson Syndrome/Erythema multiforme major, PEx(W),
Meningococcal infection, Staph Scaled Skin Syndrome SEP, SDL, ST PEx (VIVA),
(b) Infectious disorders: herpes, viral exanthemas, scabies, WBA, ITA, FEx
cellulitis, erysipelas, impetigo, fungal
(c) Atopic eczema and psoriasis
(d) Allergic reactions: urticaria, contact dermatitis

Be able to:

2.2 Describe a rash, lump, lesion or ulcer of the skin. PEx(W),

2.3 Generate a differential diagnosis and plan of management for SEP, SDL, ST PEx (VIVA),
patients with dermatological illness. WBA, ITA, FEx

TS3 Be able to:

3.1 Interpret symptoms and clinical signs of dermatological illness PEx(W),

including diagnosis of life-threatening diseases characterised by SEP, SDL, ST PEx (VIVA),
rashes. WBA, ITA, FEx

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3.15 Infectious Disorders

By the end of the relevant stage of training, demonstrate knowledge and understanding of infectious
presentations and apply this to the management of patients with these presentations in the emergency
department.

Teaching
Training
Learning outcomes & Learning Assessment
Style
Strategies

TS1 Demonstrate knowledge and understanding of:

1.1 Aetiology and pathophysiology of infectious diseases, including:

(a) Antibiotic use in the ED
(b) Systemic inflammatory response syndrome
(c) Sepsis, septic shock
(d) Multiple organ dysfunction
(e) Toxic shock syndrome
(f) Infections in the returned traveller, including:
(g) Malaria
(h) Dengue fever
(i) Haemorrhagic fevers
(j) Typhoid
(k) Zika virus
(l) Viral infections, including:
(m) HIV
(n) Infectious mononucleosis
(o) Influenza/parainfluenza
(p) Herpes simplex
(q) Herpes zoster PEx(W),
SEP, SDL, ST PEx (VIVA),
(r) Rheumatic fever, including:
WBA, ITA, FEx
1.2 Complications and long-term sequelae prevalence in at-risk
populations
(a) Antibiotic prophylaxis for sore throat
(b) Treatment protocols for high-risk groups
(c) Mycoplasma infections
(d) Fungal infections
(e) Protozoal infections
(f) Tick-borne infections
1.3 Contact management of patients with serious infectious disease,
including requirements for isolation of patients.
1.4 Principles of infection control in the ED.
1.5 Standard precautions in the ED for protection of staff from
infectious disease.
1.6 Standard protocols for the management of suspected exposure of
staff to infectious disease.
1.7 Principles of management of infectious disease outbreaks,
including surveillance protocols.
1.8 Reportable communicable diseases and protocols for reporting.

Be able to:
PEx(W),
1.9 Take a history and perform a targeted examination of a patient
SEP, SDL, ST PEx (VIVA),
with a suspected infectious disease. WBA, ITA, FEx

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Teaching
Training
Learning outcomes & Learning Assessment
Style
Strategies

TS2 Demonstrate knowledge and understanding:

2.1 Aetiology and pathophysiology of fever in the infant patient with

bacteraemia.
2.2 Aetiology and pathophysiology of:
(a) Bacterial infections, including:
i) Food poisoning
ii) Meningococcaemia
iii) Disseminated gonococcal infection
iv) Tuberculosis and other mycobacterial infections
SEP, SDL, ST WBA, ITA, FEx
v) Gas gangrene
vi) Necrotising fasciitis
vii) Fournier’s gangrene
viii) Diphtheria
ix) Haemophilus influenzae
(b) Sexually transmitted infections
(c) Infection from marine source
(d) Secondary bacterial infections in the burns patient

Be able to:

2.3 Interpret symptoms and clinical signs of infectious disease.

2.4 Interpret relevant investigations as per the investigations list.
SEP, SDL, ST WBA, ITA, FEx
2.5 Generate a differential diagnosis, plan of treatment and
disposition for patients with suspected infectious disease.

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3.16 Immunological Presentations

By the end of the relevant stage of training, demonstrate knowledge and understanding of immunological
presentations and apply this to the management of patients with these presentations in the emergency
department.

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies
TS1 Demonstrate knowledge and understanding of:
1.1 Aetiology and pathophysiology of hypersensitivity, including allergic PEx(W),
SEP, SDL,
and anaphylactoid reactions, anaphylaxis, angioedema, and drug PEx (VIVA),
ST
allergies. WBA, ITA, FEx

Be able to:
1.2 Take a history and perform a targeted examination of a patient with a PEx(W),
SEP, SDL,
suspected immunological disorder. PEx (VIVA),
ST
1.3 Treat simple allergy presentations not requiring resuscitation. WBA, ITA, FEx

TS2 Demonstrate knowledge and understanding of:

2.1 Clinical presentation of immunological disorders, including:
(a) Hypersensitivity, including:
(b) Allergic reactions, anaphylactoid reactions, anaphylaxis,
angioedema and drug allergies
(c) Collagen vascular disease
(d) Raynaud’s syndrome
(e) Reactive arthritis
(f) Scleroderma
(g) Systemic lupus erythematosus
(h) Vasculitis, including Polyarteritis nodosa and granulomatosis
with polyangiitis SEP, SDL,
WBA, ITA, FEx
(i) Kawasaki’s disease ST
(j) Sarcoidosis
2.2 Management of allergy presentations successfully responsive to
adrenaline, including the use of epinephrine autoinjectors, allergy
action plans, and referral to allergist for severe reactions, as pertain to
international guidelines on the management of severe reactions.
2.3 Complications of immunosuppressant agents.
2.4 Needs of patients with primary and secondary immunodeficiency
presenting with infection.
2.5 Application and timing of tryptase levels for anaphylaxis or acute
reaction to a specific substance.

Be able to:
2.6 Interpret symptoms and clinical signs of immunological disorders.
2.7 Recognise severe manifestations of autoimmune diseases and
SEP, SDL,
vasculitides. WBA, ITA, FEx
ST
2.8 Generate a differential diagnosis and plan of management for patients
with immunological disorders.

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3.17 Obstetric and Gynaecological Presentations

By the end of the relevant stage of training, demonstrate knowledge and understanding of obstetric and
gynaecological presentations and apply this to the management of women with these problems presenting to the
emergency department.

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies
TS2 Demonstrate knowledge and understanding of:
2.1 Principles of normal pregnancy, including antenatal screening,
physiological changes in the mother, and normal foetal development.
2.2 Pathophysiology, and principles of diagnosis and management of
gynaecological presentations, including:
(a) Retained foreign bodies
(b) Bartholin’s cyst/abscess
(c) Vulvar-vaginal infections including sexually transmitted SEP, SDL, ST WBA, ITA, FEx
diseases
(d) Endometriosis and other causes of pelvic pain
(e) Emergency contraception
(f) Complications related to contraception
(g) Ovarian pathology (torsion, cysts, tumours)
(h) Dysfunctional uterine bleeding

Be able to:
2.3 Take a history and perform a targeted examination of an obstetric
patient, including an examination of the gravid abdomen.
2.4 Take a history and perform a targeted examination of a patient with a
suspected gynaecological disorder, including bimanual and speculum
examination and genital tract specimen collection.
2.5 Interpret symptoms and clinical signs of obstetric and gynaecological SEP, SDL, ST WBA, ITA, FEx
disorders.
2.6 Generate a differential diagnosis, plan of management and
disposition for patients with gynaecological disorders.
2.7 Be culturally safe when managing collection or disposal of body
products.

TS3 Demonstrate knowledge and understanding of:

3.1 Factors that make pregnancy high risk, including multiple pregnancy,
pre-existing conditions in the mother, pregnancy-induced conditions,
and abnormalities of foetal development.
3.2 Complications of pregnancy, including:
(a) Hyperemesis gravidarum
(b) Miscarriage
(c) Septic abortion
(d) Ectopic pregnancy SEP, SDL, ST WBA, ITA, FEx
(e) HELLP syndrome
(f) First trimester bleeding
(g) Antenatal haemorrhage, including placental abruption,
placenta praevia, vasa praevia
(h) Infections, including urinary tract infections
(i) Isoimmunisation
(j) Pregnancy-induced hypertension and pre-eclampsia

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Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies
TS3 3.3 Complications of labour and delivery, and principles of their
continued management, including:
(a) Causes of Premature labour
(b) Retained placenta
SEP, SDL, ST WBA, ITA, FEx
(c) Primary and secondary postpartum haemorrhage
(d) Endometritis
(e) Retained products of conception
3.4 Effects of pharmacological agents and drugs in pregnancy.

Be able to:

3.5 Recognise deviation from normal maternal and foetal assessment,

including the use of foetal doppler.
3.6 Generate a differential diagnosis and plan of management for
obstetric patients.
PEx(W),
3.7 Perform procedures for the management of obstetric presentations, SEP, SDL, ST PEx (VIVA),
including: WBA, ITA, FEx
3.8 Removal of products of conception from cervical os.
3.9 CPR on a pregnant woman and postpartum woman.
3.10 Manage normal labour and delivery.

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3.18 Metabolic Presentations

By the end of the relevant stage of training, demonstrate knowledge and understanding of metabolic
presentations and apply this to the management of patients with these presentations in the emergency
department.

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS1 Demonstrate knowledge and understanding of:

1.1 Volumes and composition of total body water, intracellular fluid,

extracellular fluid, plasma and blood.
1.2 Aetiology and pathophysiology of disorders of abnormal serum,
including potassium, sodium, calcium, magnesium and chloride.
1.3 Principles of arterial and venous blood gas analysis, including PEx(W),
alveolar gas equation and A-a gradient. SEP, SDL, ST PEx (VIVA),
1.4 Aetiology and pathophysiology of acid-base disorders, including: WBA, ITA, FEx
(a) Metabolic acidosis
(b) Metabolic alkalosis
(c) Respiratory acidosis
(d) Respiratory alkalosis

Be able to:

1.5 Take a history and perform a targeted examination of a patient with a

suspected metabolic disorder. PEx(W),
1.6 Interpret symptoms and clinical signs of metabolic illness. SEP, SDL, ST PEx (VIVA),
1.7 Undertake clinical examination of the patient with a metabolic WBA, ITA, FEx
disorder.

TS2 Demonstrate knowledge and understanding of:

2.1 Investigations to determine anion and osmolar gaps, and the use of
these in diagnosis and management of patients.
SEP, SDL, ST WBA, ITA, FEx
2.2 Indications, contraindications and side effects of sodium bicarbonate
administration.

Be able to:

2.3 Generate a differential diagnosis, plan of management and

SEP, SDL, ST WBA, ITA, FEx
disposition for patients with suspected metabolic disorders.

TS3 Be able to:

3.1 Interpret relevant investigations as per the investigations list

including:
(a) electrocardiograph in electrolyte disturbance. SEP, SDL, ST WBA, ITA, FEx
(b) arterial and venous blood gases. TS1 and TS3 for advanced
analysis

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3.19 Orthopaedic Presentations

By the end of the relevant stage of training, demonstrate knowledge and understanding of orthopaedic
presentations and apply this to the management of patients with these presentations in the emergency
department.

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies
TS1
Demonstrate knowledge and understanding of:

1.1 Principles of fractures and their assessment, including:

(a) Clavicle, scapula
(b) Proximal humerus, elbow, forearm, wrist, carpal bones
(c) Spine
(d) Pelvis, hip
(e) Femur, including femoral shaft, supracondylar, condylar and
patella fractures
(f) Tibia, fibula, angle and foot
1.2 Principles of dislocations and their assessment, including:
(a) Shoulder, acromioclavicular joint
(b) Elbow, including pulled elbow
(c) Carpal-metacarpal, phalanges
(d) Cervical spine, including atlantoaxial, facet joint
(e) Hip
(f) Knee, patella
(g) Ankle, foot, tarsal, metatarsal, phalangeal
1.3 Principles of soft tissue injuries, assessment and management,
including: PEx(W),
(a) Shoulder: rotator cuff tears, bursitis, tendinitis SEP, SDL, ST PEx (VIVA),
(b) Elbow: bursitis, tendinitis WBA, ITA, FEx

(c) Knee: bursitis, ligament injury, cruciate injury, meniscal

injury, Bakers cyst
(d) Ankle, foot: ligament, tendon injury
1.4 Principles of hand injuries and their assessment, including:
(a) Lacerations
(b) Nail injuries
(c) Extensor and flexor tendon injuries
(d) Mallet finger
(e) Boutonniere deformity
(f) Infections: paronychia, infective tenosynovitis
(g) Foreign bodies
(h) Amputations
(i) Nerve injuries
(j) High pressure injection injuries
(k) Crush injury
1.5 Principles of other orthopaedic presentations, including
osteomyelitis, and septic arthritis.

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Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies
TS1
continued Be able to:
1.6 Take a history and perform a targeted and culturally safe examination
of a patient with a suspected orthopaedic disorder or injury,
including neurological, vascular and joint assessment.
1.7 Interpret symptoms and clinical signs of orthopaedic disorders and
injuries. PEx(W),
SEP, SDL, ST PEx (VIVA),
1.8 Interpret radiological assessment of injured limbs.
WBA, ITA, FEx
1.9 Independently perform:
(a) Limb splinting, including the use of femoral and tibial
traction devices, collar and cuff, broad arm slings
(b) Joint reduction of digits

TS2 Demonstrate knowledge and understanding of:

2.1 Principles of management in the ED of fractures, dislocations and

SEP, SDL, ST WBA, ITA, FEx
soft tissue injuries.

Be able to:

2.2 Generate a differential diagnosis and plan of management for

patients with orthopaedic disorders and injuries.
2.3 Perform procedures for the management of orthopaedic
presentations, including:
(a) Application of plaster splints/casts on limbs
(b) Drainage of paronychia
(c) Drainage of subungual haematoma
(d) Splintage and immobilisation techniques, including
application of:
(e) Broad arm sling SEP, SDL, ST WBA, ITA, FEx
(f) Collar and cuff
(g) Knee immobiliser/splint
(h) Femoral splints
(i) Ankle splints and controlled action motion walking boots
(j) Pelvic stabilisation techniques
2.4 Perform the following procedures on trauma patients:
(a) Major joint reduction
(b) Emergent fracture reduction in an impending compromised
limb

TS3 Demonstrate knowledge and understanding of:

3.1 Principles of other orthopaedic presentations, including:

(a) Overuse syndromes SEP, SDL, ST WBA, ITA, FEx
(b) Complex regional pain syndrome type 1 (Sudeck’s atrophy)

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Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies
TS3 3.2 Paediatric considerations in orthopaedics, including:
continued
(a) Salter-Harris classification
(b) Injuries about the elbow
(c) Child with a limp
(d) Bone dysplasia
(e) Connective tissue syndrome
(f) Inflammatory arthritis SEP, SDL, ST WBA, ITA, FEx
(g) Metabolic bone abnormalities
(h) Osgood/Schlatter disease
(i) Perthes’ disease
(j) Slipped capital femoral epiphysis
(k) Transient synovitis
(l) Developmental hip dislocation

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3.20 Trauma

By the end of the relevant stage of training, demonstrate a contemporary evidence-based knowledge and
understanding of trauma and apply this knowledge to the management of trauma patients.

Reference should also be made to 4.1.2.3 Resuscitation Medicine, 4.1.3.5 Ophthalmological Presentations, 4.1.3.8
Toxicological and Environmental Presentations and 4.1.3.19 Orthopaedic Presentations.

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies
TS1 Demonstrate knowledge and understanding of:
1.1 Mechanisms of injury.
1.2 Principles of trauma management, including:
(a) Classification and description of fractures, dislocations,
sprains and strains
PEx(W),
(b) Fracture, wound and burn healing
SEP, SDL, ST PEx (VIVA),
(c) Pathophysiology of hypovolaemic shock WBA, ITA, FEx
1.3 Epidemiology of trauma, including:
(a) Trimodal peak of mortality
(b) Relationships between injury mechanisms, patterns and
prognosis, particularly blunt and penetrating trauma
Be able to:
1.4 Identify the trauma patient who requires initiation of resuscitation.
1.5 Complete a primary trauma survey in an injured non-complex adult
patient, incorporating point of care testing as required, and identify
life-threatening abnormalities requiring emergent intervention.
1.6 Complete a culturally safe secondary trauma survey who no longer
requires ongoing resuscitation or critical care interventions.
1.7 Perform a comprehensive culturally safe limb examination, including
neurological, vascular and joint assessment.
1.8 Apply concepts of healing by primary and secondary intention to the
creation of treatment plans for non-complex open wounds.
1.9 Identify and manage the following in trauma patients:
(a) Scalp and other laceration
(b) Removal of superficial and subcutaneous foreign bodies
PEx(W),
(c) Minor head injury, including post-concussive syndrome SEP, SDL, ST PEx (VIVA),
(d) Sprains and strains of joints WBA, ITA, FEx
(e) Burns not requiring immediate transfer to a Burns Unit
1.10 Perform relevant simple initial treatment procedures, including:
(a) Spinal protection and clearance
(b) Pelvic binding/splinting
(c) Intravenous or intraosseous access
(d) Supportive management of orthopaedic injuries
(e) Basic skin suturing techniques and alternate skin closure,
including tissue adhesives and staples
1.11 Prescribe appropriate analgesia for a patient, including the use of
physical therapy.
1.12 Create a discharge and follow-up plan for a patient from the ED,
incorporating likely health progression from injury.

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Teaching
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Learning outcomes & Learning Assessment
Stage
Strategies

TS2 Demonstrate knowledge and understanding of:

2.1 Principles of trauma, including:

(a) Trauma resuscitation
(b) Trauma coagulopathy
2.2 Trauma systems, including:
(a) Prehospital transport, communication and handover
(b) Trauma centre designation and trauma triage
(c) Interhospital transport
(d) Trauma registry
2.3 Trauma scoring systems, epidemiology, incidence, and patterns of
injury, including the following populations:
(a) Paediatric patients
(b) Geriatric patients
(c) Patients on multiple medications
(d) Obstetric patients
(e) Bariatric patients
(f) Vulnerable patients following assault
(g) Patients with penetrating versus blunt trauma SEP, SDL, ST WBA, ITA, FEx
2.4 Pathophysiology of clinical signs and symptoms due to breathing,
circulatory, and neurological injury.
2.5 Principles of assessment of the trauma patient, including:
(a) Trauma triage
(b) Primary, secondary and tertiary survey
(c) Severity of hypovolaemic shock
(d) Systematic assessment of life threats
(e) Systematic assessment of multitrauma
(f) Roles and pitfalls of vital signs, such as heart rate, blood
pressure, saturations, respiratory rates, non-invasive
and core temperature, Glasgow Coma Scale, blood sugar,
pupillary reflexes, neurovascular status of distal limbs
(g) Point of care testing, such as x-ray, bedside ultrasound,
blood gas, urinalysis, blood sugar
(h) Rational investigation choice, including radiology, other
medical imaging, lab tests including thromboelastometry
(i) Culturally and psychologically safe and supported inclusion
of family/whānau

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Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies
TS2 2.6 Principles of trauma management, including:
continued
(a) Multidisciplinary approach
(b) Early management of severe trauma
(c) Advanced trauma life support
(d) Damage control resuscitation
(e) Indications for conservative versus operative management
(f) IV fluid choices and uses in trauma
(g) Blood transfusion and component therapy, including
massive transfusion, and cultural and religious differences
surrounding receipt of blood products
(h) Indications and preparation for intra- and inter-hospital
transfer of the trauma patient
(i) Trauma patient rehabilitation, including the risk of secondary
psychiatric injury
2.7 Classification, description and principles of management of trauma
presentations, including:
(a) Head trauma
(b) Maxillofacial trauma
(c) Neck injuries WBA, ITA, FEx
SEP, SDL, ST
(d) Vertebral column and spinal cord injuries
(e) Chest trauma
(f) Abdominal trauma
(g) Major pelvic injury
(h) Genitourinary trauma
(i) Extremity trauma, including traumatic amputation, arterial
injury, compartment syndromes and crush syndrome
(j) Hypothermia and hyperthermia
(k) Burns requiring admission, including:
i) Inhalation injury
ii) Chemical burns
iii) Electrical burns
iv) Tar burns
v) Sunburn
vi) Oral burns
2.8 Principles of fluid resuscitation in trauma.
2.9 Principles of blood product resuscitation in trauma, including
massive transfusion protocols.

Be able to:
2.10 Appraise and apply local clinical guidelines related to trauma
management.
2.11 Perform the following procedures:
(a) Wound exploration, cleaning, irrigation and debridement,
SEP, SDL, ST WBA, ITA, FEx
(b) Incision and drainage of simple, superficial abscesses
(c) Apply superficial wound dressings
(d) Pack open wounds
(e) Drainage of subungual haematomas

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Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies
TS2 2.12 Contribute to providing first line resuscitative treatment to a trauma
continued patient, including a patient in cardiac or respiratory arrest.
2.13 Perform procedures that provide ongoing stability of the patient
post-resuscitation and prior to admission.
2.14 Create a safe disposition plan for a trauma patient requiring SEP, SDL, ST WBA, ITA, FEx
admission.
2.15 Justify prioritisation of multiple tasks in a single trauma patient.
2.16 Justify prioritisation of multiple injuries based on injury severity,
likelihood of consequences to patient, facilities available in the ED.

TS3 Demonstrate knowledge and understanding of:

3.1 The importance of public health advocacy in relation to trauma,

including:
(a) Role of public education, trauma prevention programs, and
legislation as pertains to trauma occurrence
(b) Local trauma epidemiology, including patterns of domestic
violence and child abuse
3.2 Trauma scoring systems.
3.3 Pathophysiology of sequelae from inadequately treated or
unidentified injuries and their complications.
+ Principles underpinning trauma teams, including:
(a) Structure and role of trauma teams in the reception and
management of severe trauma
(b) Principles of Crisis Resource Management
(c) Contributions of other medical disciplines in trauma
management, such as pre-hospital and retrieval medicine,
anaesthesia, surgery, intensive care medicine, radiology
3.4 Trauma team training. SEP, SDL, ST WBA, ITA, FEx
3.5 Leadership in the management of trauma patients with varied
severity in the hospital environment/network.
3.6 Pathophysiology of life-threatening injuries and their relationship to
mechanism of injury.
3.7 Principles of common lifesaving procedures in the critically injured
patient.
3.8 Pathophysiology of multisystem trauma.
3.9 Physiological effects of medications and fluids used in resuscitation
of multitrauma patients.
3.10 Beyond the Resuscitation Room management of the severely injured
trauma patient, including prioritising the order of interventional
radiology, timing to operating theatre versus time to CT.
3.11 Complications of resuscitation in the trauma patient.
3.12 Production of false vital signs based on co-morbidities and patient’s
ongoing medication use.

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Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies
TS3 3.13 Adaptations to principles of management of trauma in special cases,
continued including the following:
(a) Paediatric population, including non-accidental injury
(b) Obstetric population, including obstetric complications of
trauma and uterine rupture
(c) Elderly trauma population
SEP, SDL, ST WBA, ITA, FEx
(d) Bariatric patients
(e) Multiple casualties/disaster
(f) Patient(s) on multiple medications
(g) Vulnerable patient(s) post-assault

3.14 Role of the Coroner in trauma patients.

Be able to:

3.15 Resuscitate a critically injured patient with an expanded range

of therapies beyond first line treatments, including haemostatic
resuscitation.
3.16 Principles of balanced blood product resuscitation, including
viscoelastic haemostatic testing guidance.
3.17 Assess and resuscitate a high-complexity patient due to comorbid
conditions, including:
(a) Coagulopathy
(b) Cardiorespiratory illness
(c) Reduced physiological reserve, such as in patients with renal
conditions, diabetes and elderly and paediatric patients
3.18 Diagnose multiple injuries.
3.19 Provide specialised emergency treatment to the following injuries:
(a) Eye, ear, and maxillofacial injuries, including reduction of SEP, SDL, ST WBA, ITA, FEx
temporo-mandibular joint
(b) Dental injuries, including stabilising an injured tooth and
bleeding following dental extraction
(c) Severe burns requiring transfer to Burns Unit
(d) Penetrating wounds, including those into joints, thoracic
cavity, and abdominal cavity
(e) Solid intra-abdominal and intrathoracic organ injury
(f) Moderate and severe head injury,
(g) Traumatic limb injury necessitating amputation
3.20 Initiate treatment to prevent short term complications of injuries,
including raising intracranial pressure and compartment syndromes.
3.21 Perform tertiary trauma survey assessment for patients in the Short
Stay Unit of the ED.
3.22 Co-ordinate the discharge of the trauma patient.

TS4 Be able to:

4.1 Create a resuscitation and treatment plan for a multitrauma patient

SEP, SDL, ST WBA, ITA, FEx
in an austere environment.

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3.21 Paediatric Presentations

By the end of the relevant stage of training, demonstrate knowledge and understanding of paediatric
presentations and apply this to the management of these patients in the emergency department. Paediatric
patients are defined as those under 16 years of age.

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS1 Demonstrate knowledge and understanding of:

1.1 Comparative anatomy and physiology of the newborn, 2 year old, 5

year old, and adolescent.
1.2 Pathophysiology of non-critical illness and injury in children, as
compared to adults.
1.3 Approach to the assessment of a paediatric patient, with
consideration of age and development of the child, use of age
appropriate communication and assessment tools e.g., HEADSSS
assessment.
1.4 Paediatric considerations of fundamental pharmacological principles,
including pharmacokinetics, drug metabolism and weight-based
prescribing.
1.5 Conduct a brief initial assessment of a child to determine the
requirement for resuscitation. PEx(W),
SEP, SDL, ST PEx (VIVA),
1.6 Indications, contraindications, complications and basic medical WBA, ITA, FEx
science principles underpinning the procedures to be performed
independently by the end of TS1.
1.7 Understand the concept that children live within the context of
families, society, schools and extended families.
1.8 Public health as pertains to paediatric emergency medicine.
1.9 The special needs of vulnerable children, including those in
temporary care, looked after children, children with chronic illness,
children at risk of harm and those that live in situations of domestic
violence and poverty.
1.10 Understand the importance of public health promotion in paediatrics
including promotion of breast feeding, accident prevention,
immunisations, water safety, creating safe homes.

Be able to:

1.11 Recognise the severely ill or deteriorating child and recruit help when
treating, as required.
1.12 Demonstrate suitable approaches to vulnerable children
1.13 Perform basic life support in the arrested child, including the relevant
algorithms. PEx(W),
1.14 Provide standard first line treatment in advanced paediatric life PEx (VIVA),
SEP, ST
support algorithms for the critically ill or injured child. WBA, ITA,
1.15 Independently perform the following airway and breathing PER, FEx
procedures:
(a) Basic airway manoeuvres
(b) Insertion of oropharangeal or nasopharyngeal airway
(c) Use of self-inflating bag for ventilation

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Teaching
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Learning outcomes & Learning Assessment
Stage
Strategies
TS1 1.16 Independently perform the following circulation procedures:
continued
(a) External chest compressions
(b) Defibrillation (manual and AED)
(c) Venipuncture
(d) Arterial puncture for blood sampling
1.17 Independently perform the following neurological and orthopaedic
procedures:
(a) In-line cervical spine immobilisation
(b) Full spinal immobilisation, log roll, transfer
(c) Backslab application
(d) Application of sling/collar and cuff
PEx(W),
1.18 Assess pain in a paediatric patient and prescribe analgesia, including PEx (VIVA),
suitable adjuncts. SEP, ST
WBA, ITA,
1.19 Independently perform the following sedation and anaesthesia PER, FEx
procedures:
(a) Topical anaesthesia
(b) Direct infiltration of local anaesthetic
(c) Digital nerve block
1.20 Perform basic skin suturing techniques and alternate skin closure,
such as tissue adhesive, staples.
1.21 Analyse and interpret investigations performed in paediatric patients,
including blood tests and plain radiology images.
1.22 Independently perform direct ophthalmoscopy.
1.23 Independently perform the removal of superficial foreign bodies from
nose and ear.

TS2 Demonstrate knowledge and understanding of:

2.1 Patterns in presentation of non-critical illness and injury in children

of various age groups (under 3 months, 3 months to 2 years, 2 to 5
years, 5 to 12 years, adolescent), including:
(a) Fever
(b) Dehydration
(c) Vomiting
(d) Crying infant
(e) Abdominal pain
(f) Rash
(g) Feeding problems
(h) Head injury WBA, ITA,
SEP, SDL, ST
PER, FEx
(i) Congenital syndromes (e.g., Trisomy 21)
(j) Gastroesophageal reflux
(k) Ovarian and testicular torsion
(l) Bronchiolitis, viral induced wheeze
(m) Asthma
(n) Respiratory tract infection
(o) Anaphylaxis
(p) Haematological presentations (as per John)
(q) Soft tissue and bony injuries (as per John)
(r) Non accidental, inflicted injuries and neglect

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Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies
TS2 2.2 Pathophysiology of critical illness and injury in children and how this
continued differs to adults.
2.3 Patterns in presentations of critical illness and injury, including
toxicological, trauma, and sepsis in children of various age groups
(newborn, under 3 months, 3 months to 2 years, 2 to 5 years, 5 to 12
years, adolescent), including:
(a) The collapsed neonate
(b) Congenital heart disease
(c) Arrhythmia
WBA, ITA,
(d) Metabolic disease SEP, SDL, ST
PER, FEx
(e) Respiratory distress
(f) Seizures, altered mental state
(g) Infections/sepsis, including occult bacteraemia
(h) Acute behavioural disturbance
(i) Sudden Unexplained Death in an Infant
2.4 Physiological changes occurring in the newborn at birth.
2.5 Common presentations in the newborn within four hours of birth.
2.6 Approaches to functional complaints in children.

Be able to:

2.7 Apply evidence-based care to a broad range of paediatric

presentations.
2.8 Undertake a focused history and physical examination for a patient
less than 3 months, less than 24 months, a preschool-aged child, and
an older child with non-critical presentations.
2.9 Take into consideration the impact of illness and injury on families
and siblings when treating children.
2.10 Create an appropriate investigation plan for a complex paediatric
presentation.
2.11 Generate an appropriate provisional and differential diagnosis
relevant to the age of the patient for non-critical care presentations
of low and medium complexity.
2.12 Organise and initiate an appropriate treatment plan for children with
common non-critical diagnoses.
2.13 Formulate a management plan for psychiatric acute crises in WBA, ITA,
SEP, SDL, ST
paediatric patients. PER, FEx
2.14 Utilise observational medicine appropriately when managing
paediatric patients.
2.15 Recognise a critically ill, injured or deteriorating child and activate
appropriate systems, including calling for help.
2.16 Tailor an initial treatment plan to the patient based on the problems
presented and the provisional diagnosis, as applicable.
2.17 Create initial treatment plans for the specific diagnoses found in non-
critically ill or injured children.
2.18 Modify the initial treatment plan in response to newly discovered
information to create a definitive treatment and discharge plan.
2.19 Transfer discharge plans to the responsible parent/carer, GP services,
and other health agencies.
2.20 Summarise salient points when presenting patient at handover or
when referring to inpatient services.

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Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies
TS2 2.21 Independently perform the following airway and breathing
continued procedures:
(a) Insertion of a laryngeal mask airway
(b) Nasogastric and orogastric tube insertion
2.22 Independently perform the following circulation procedures:
(a) Paediatric peripheral intravenous access
(b) Intraosseous access
(c) Preparation and operation of transport monitoring
equipment
2.23 Independently perform the following fluids procedures:
(a) Non-invasive urine collection WBA, ITA,
SEP, SDL, ST
(b) Insertion of an infant urinary catheter (male & female) PER, FEx
(c) Suprapubic aspiration of urine in an infant, with and without
ultrasound guidance
(d) Lumbar puncture and measurement of CSF opening pressure
2.24 Independently perform the following orthopaedic procedures:
(a) Pelvic binding device, traction splinting
(b) Emergency reduction of fracture or major joint dislocation.
2.25 Manage behavioural disturbance in paediatric patients.
2.26 Independently perform the following ENT and eye procedures:
(a) Removal of corneal foreign bodies
(b) Use of slit lamp in the eye examination
TS3
Demonstrate knowledge and understanding of:

3.1 Medications and other substances that, if a single adult dose is

ingested by a child, is potentially lethal.
3.2 Principles of first line treatment in newborn resuscitation, including
the use of the infant resuscitaire.
3.3 Adolescent presentations and their multidisciplinary management
3.4 Modifications to assessment and management of illness and injury in
children with the following co-morbidities:
(a) Acute behavioural disturbance
(b) Functional disorders
(c) Behavioural disorders such as autistic spectrum and ADHD WBA, ITA,
SEP, SDL, ST
PER, FEx
3.5 Principles of chronic disease management in paediatric patients.
3.6 Indications, contraindications, complications and basic medical
science principles underpinning the procedures to be performed
independently by the end of TS3.
3.7 Initiate appropriate time critical interventions for a child, such as bag
valve mask ventilation.
3.8 Generate an appropriate provisional and differential diagnosis
relevant to age for high complexity patients, including post-
resuscitation patients.
3.9 Appropriately use critical care monitoring equipment.

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Teaching
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Learning outcomes & Learning Assessment
Stage
Strategies
TS3
Be able to:
continued
3.10 Independently perform the following airway and breathing
procedures:
(a) Use of non-self-inflating bag (T-piece) for ventilation/neopuff
(b) Use of paediatric non-invasive ventilation device (high flow
nasal cannula therapy, if available, mask CPAP/BiPAP and
bubble CPAP)
(c) Direct laryngoscopy, insertion of oral ETT, use of RSI
technique
(d) Securing and caring for ETT, including during transport
(e) Emergency replacement of blocked or dislodged
tracheostomy tube
(f) Set up a transport ventilator WBA, ITA,
SEP, SDL, ST
(g) Decompression needle/finger thoracostomy PER, FEx
(h) Tube thoracostomy
3.11 Independently perform the following circulation procedures:
(a) DC cardioversion
(b) External pacing
3.12 Independently perform the following fluids procedures:
(a) Emergency replacement of a dislodged gastrostomy tube
3.13 Independently administer:
(a) Procedural sedation
(b) Femoral nerve block
(c) Fascia iliaca block

TS4 Demonstrate knowledge and understanding of:

4.1 Principles of troubleshooting resuscitation when a patient does not

respond to first line therapy and/or standard resuscitation methods.
4.2 Principles of managing patient flow and communication with teams to WBA, ITA,
SEP, SDL, ST
best service paediatric patients. PER, FEx
4.3 Clinical governance and safety of paediatric patients attending
emergency departments.

Be able to:

4.4 Perform standard first line treatment in neonatal resuscitation.

4.5 Resuscitate a child who does not respond to first line therapy or
standard paediatric resuscitation algorithms.
4.6 Demonstrate a safe approach to the ongoing management of a
critically ill or injured child prior to transfer to a definitive paediatric
WBA, ITA,
critical care unit. SEP, SDL, ST
PER, FEx
4.7 Prepare a stabilised critically ill/injured child for transport to a
definitive paediatric critical care unit or for retrieval to another
hospital.
4.8 Independently administer peripheral nerve blocks other than femoral
nerve or fascia iliaca block.

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3.22 Geriatric Emergency Medicine

By the end of the relevant stage of training, demonstrate knowledge and understanding of geriatric presentations
and apply this to the management of these patients in the emergency department. It is acknowledged that the
majority of presentations in the adult sections of this curriculum are applicable to older patients but may have
different differential diagnoses. Geriatric patients are defined as those 65 years of age or older, though it is
recognised that determinants other than the patient’s chronological age, including physiological, pathological,
psychological, and social factors, may impact the need for geriatric expertise.

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS1 Demonstrate knowledge and understanding of:

1.1 Physiological changes of ageing.

1.2 Changes in pharmacokinetics and pharmacodynamics in older
patients.
1.3 Polypharmacy and adverse reactions, including drug-drug and drug-
disease interactions.
1.4 Geriatric syndromes and their relevance to emergency management
of older persons including:
(a) Frailty
PEx(W),
(b) Delirium (including subtypes) SEP, SDL, ST PEx (VIVA),
(c) Falls WBA, ITA, FEx
(d) Pressure injury
(e) Incontinence
1.5 Increased prevalence of cognitive and sensory impairments in older
patients and their impact on;
(a) Increased risk of accidental injury
(b) Increased risk of accidental overdose
(c) Assessment and management in the ED

Be able to:

1.6 Elicit a history from older persons, their family/whānau and carers.
1.7 Perform a medication review, especially for older persons presenting
with falls or with polypharmacy.
1.8 Identification and progression of pathology in common presentations
of older people.
1.9 Pain assessment and management in older persons and in those with
cognitive impairment.
1.10 Modifications to emergent interventions for older patients based on
anatomical or physiological changes, risk assessment and goals of
care. PEx(W),
SEP, SDL, ST PEx (VIVA),
1.11 Trauma management in older persons, including the increased risk of
WBA, ITA, FEx
potentially avoidable complications.
1.12 Assessment and management (non-pharmacological and
pharmacological) of behavioural disturbance in older patients.
1.13 Identification, management and prevention of iatrogenic injuries and
their complications, including those associated with:
(a) Bladder catheterisation,
(b) Spinal immobilisation,
(c) Invasive line placement
(d) Skin tears and pressure injuries

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Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies
TS1 1.14 Altered laboratory findings and interpretation of investigations in
continued older patients.
1.15 Common presentation patterns in older patients, including:
(a) Delirium PEx(W),
SEP, SDL, ST PEx (VIVA),
(b) Abdominal pain WBA, ITA, FEx
(c) Falls or collapse
(d) Sepsis and common causes of infection
(e) Chronic wounds
TS2
Demonstrate knowledge and understanding of:

2.1 Risks of under-triage in older patients.

2.2 Discharge risk assessment and multidisciplinary team assessment in
older persons.
2.3 Optimising transitions of care including specific discharge needs of
older persons living in residential aged care.
2.4 Signs and injury patterns that suggest elder abuse.
2.5 Law and ethics in the care of older persons, including: SEP, SDL, ST WBA, ITA, FEx
(a) Advance care directives and hierarchy of substitute decision
makers
(b) Defining goals of care
(c) Involvement of the coroner
2.6 Atypical and subtle presentations of disease in older persons and the
increased risk of diagnostic error.

Be able to:
2.7 Assess and manage common geriatric emergencies and presentations,
including:
(a) Geriatric trauma, including falls and hip fracture
(b) Weakness, immobility,
(c) Dizziness, balance and gait disorders
(d) Cognitive, behavioural and psychological/mood disorders,
including dementia, delirium, depression and anxiety
(e) Side effects from polypharmacy use
(f) Toxicological presentations, including acute and chronic,
intentional and accidental
(g) Skin care / chronic wounds
SEP, SDL, ST WBA, ITA, FEx
2.8 Provide end of life care for the older patient in the ED.
2.9 Co-ordinate a functional assessment in the older patient, including
mobility assessment, Activities of Daily Living (ADLs) and Instrumental
ADLs, and incorporate findings into the management plan.
2.10 Generate a differential diagnosis for an older patient’s presentation.
2.11 Screen for comorbid conditions and potential complications of
current treatment.
2.12 Screen the home environment details, including availability, capability
and stress of formal and informal caregivers.
2.13 Co-ordinate the care of older patients, involving multiple different
agencies as required.

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| Medical Expertise Clinical Management in Emergency Medicine |

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS3 Be able to:

3.1 Safely perform procedures in older patients, with recognition and

treatment of iatrogenic injuries and complications when they occur.
3.2 Manage incidents of abuse and neglect, in accordance with
SEP, SDL, ST WBA, ITA, FEx
institutional and state guidelines.
3.3 Recruit an increased variety of agencies when managing older
patients with concurrent medical and mood disorders.

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| Medical Expertise Clinical Management in Emergency Medicine |

3.23 Procedures in Emergency Medicine

Emergency Medicine Physicians are expected to:

+ Demonstrate understanding of how the procedure is performed, indications, contraindications and potential
complications, underpinned by knowledge of the basic sciences that form the foundations of emergency medicine.
+ Decide to conduct the procedure during the clinical assessment of the patient’s presentation.
+ Be able to prepare the patient (education, consent, positioning), equipment, medications, and staff for the
procedure.
+ Be able to technically perform the procedure, efficiently and safely.
+ Maintain situational awareness, managing any complications if they arise during and/or after the procedure.
+ Provide appropriate post-procedure management, including follow-up investigations, clinical care and
documentation.
+ Provide appropriate discharge advice to the patient and/or carers.
For almost all procedures listed here, and further detailed in the Medical Expertise domain of the FACEM
Curriculum, Emergency Medicine Physicians are required to perform them independently, though a select few
may be performed under supervision of suitably credentialled clinicians. The list provides guidance as to the
level of mastery expected of trainees as they progress through the stages of the FACEM Training Program. A level
of independence has been assigned to each stage of training for each procedure. It is expected that trainees
will acquire the requisite knowledge and skills to perform the procedure under direct supervision (S) of senior
clinicians and advance to independent (I) performance, using at least one approach, with further experience and
consolidation of skill, in both simulated and real patient interactions. It is acknowledged that these assigned
mastery levels are based on performance in non-challenging situations.

Procedures listed as common in emergency medicine (C) should present opportunities to master performance in
real patient encounters. For those procedures categorised as life/limb/sight saving (LS), trainees are expected
to achieve the mastery level at least in simulation if real life opportunities to practice this procedure are rare.

All procedures are learned through the accredited training site’s structured education program and via supervised
training and are assessed in workplace-based assessments (WBAs) and through relevant questions in all
examinations. In addition, the following procedures are considered core to emergency medicine practice, and are
formally assessed as part of the Procedural Requirement:

Procedure Performed on Assessed in

Advanced airway Adult patient ED

Procedural sedation Adult patient ED

Regional anaesthesia (Bier’s or peripheral nerve block) Adult or paediatric patient ED

Emergent fracture reduction (wrist, ankle) Adult or paediatric patient ED

Reduction of dislocated major joint (shoulder, elbow, hip) Adult or paediatric patient ED

DC cardioversion Adult or paediatric patient ED

Ultrasound – eFAST, AAA, Lung, FELS Adult or paediatric patient ED

Corneal foreign body removal or nasal passage packing Adult or paediatric patient ED
ED or Critical Care or
Tube thoracostomy Adult or paediatric patient
Trauma SSP
Lumbar puncture Adult or paediatric patient ED or Critical Care
ED or Critical Care or
Central venous access Adult or paediatric patient
Trauma SSP
ED or Critical Care or
Arterial line insertion Adult or paediatric patient
Trauma SSP

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| Medical Expertise Clinical Management in Emergency Medicine |

Procedures in Emergency Medicine

Category Level of mastery
PROCEDURE C = common in EM S = under direct supervision
* See Procedural Requirement on p.108 LS = life/limb/sight I = independent
saving
End TS1 End TS2 End TS3 End TS4
Infection control
Aseptic and sterile technique C I
Airway
Basic airway manoeuvres
C, LS I
Chin lift, jaw thrust, head tilt, positioning
Insertion of oropharangeal or nasopharyngeal
C, LS I
airway
Insertion of a laryngeal mask airway C, LS S I
Direct laryngoscopy, insertion of oral ETT, use of
RSI technique* C, LS S I
Including drugs, stylet, bougie

Video laryngoscopy* C, LS S I

Use of other rescue difficult airway device LS S I

Securing and caring for ETT including during
C, LS S
transport
Insertion of cricothyroid needle and jet
insufflation of oxygen (adult & child) LS S I
Cricothyroidotomy LS S I
Emergency replacement of blocked or dislodged
tracheostomy tube LS S I
Extubation I
Indirect laryngoscopy
I
Use of dental mirror to examine for FB
Breathing
Spirometry and Peak Flow measurement C S I
Use of oxygen delivery devices C, LS I
Use of self-inflating bag for ventilation C, LS I
Use of a non-self-inflating bag for ventilation S I
Use of adult non-invasive ventilation device C, LS S I
Use of paediatric non-invasive ventilation device LS S I
Setting up a transport ventilator C, LS S I
Decompression needle/finger thoracostomy C, LS S I
Pleurocentesis C S I
Tube thoracostomy* C, LS S I
Circulation
External Chest Compressions
C, LS I
Infant, paediatric, adult
Defibrillation C, LS I
DC cardioversion* C, LS S I
External pacing LS S I
Venipuncture C I
Adult peripheral intravenous access C, LS I
Paediatric peripheral intravenous access C,LS S I
Insertion of a rapid infusion catheter LS I

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| Medical Expertise Clinical Management in Emergency Medicine |

Procedures in Emergency Medicine

Category Level of mastery
PROCEDURE C = common in EM S = under direct supervision
* See Procedural Requirement on p.108 LS = life/limb/sight I = independent
saving
End TS1 End TS2 End TS3 End TS4
Circulation continued
Intraosseous access C, LS S I
Arterial puncture for blood sampling C I
Arterial line insertion* C S I
Preparation & operation of transport monitoring
C I
equipment
Insertion of a central venous line* C I
Emergency pericardiocentesis LS I
Resuscitative thoracotomy LS S
Insertion of a temporary pacing wire LS S
Fluids
Preparation of an intravenous fluid or blood
C I
product line
Insertion of a nasogastric tube or orogastric tube C I
Insertion of an adult urinary catheter C I
Insertion of an infant urinary catheter C S I
Suprapubic aspiration of urine in an infant C S I
Insertion of a suprapubic catheter I
Replacement of a suprapubic catheter C S I
Abdominal paracentesis and insertion of drain C S I
Insertion of oesophageal & gastric balloon
LS I
devices
Emergency replacement of a dislodged
C S I
gastrostomy tube
Orthopaedic & Neurological
Sizing and application of a rigid cervical collar C, LS I
In-line cervical spine immobilisation C, LS I
Full spinal immobilisation, log roll, and transfer C, LS I
Emergent Fracture / Dislocation Reduction* C, LS S I
Joint reduction – Digits C I
Joint reduction – major joints* C, LS S I
Fracture/Joint immobilisation techniques,
C S I
including limb splinting
Fracture/Joint immobilisation – Backslab
C I
application
Application of sling/ collar and cuff C I
Insertion of a fascial intra-compartmental
S
monitor
Application of a pelvic binding device C, LS S I
Application of traction splinting devices C, LS S I
Arthrocentesis (knee) C S I
Sedation delivery
Administration of procedural sedation* C S I
Administration of chemical restraint C S I

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Procedures in Emergency Medicine

Category Level of mastery
PROCEDURE C = common in EM S = under direct supervision
* See Procedural Requirement on p.108 LS = life/limb/sight I = independent
saving
End TS1 End TS2 End TS3 End TS4
Regional anaesthesia
Use of topical anaesthesia C I
Direct infiltration of local anaesthetic C I
Digital Nerve Block C I
Femoral nerve and fascia iliaca block* C S I
Other peripheral nerve blocks S I
Intravenous anaesthesia and Biers block* S I
Wounds
Basic skin suturing techniques C I
Alternate skin closure
C I
Tissue adhesive, staples
Advanced suturing techniques C S I
Wound exploration, cleaning, irrigation, and
C S I
debridement
Superficial open wound dressing C S I
Open wound packing C S I
Burns
Burn first aid C I
Primary burn dressing C I
Escharotomy LS I
Minor Surgical
Removal of superficial & subcutaneous foreign
C I
bodies
Incision and drainage of simple, superficial
C S I
abscesses
Drainage of a paronychia C S I
Drainage of a subungual haematoma C S I
Incision and drainage of a thrombosed external
C S I
haemorrhoid
Drainage of peritonsillar abscess S
Nail bed repair C S
Obstetric & Gynaecological
Vaginal speculum insertion C S I
Removal of products of conception from cervical C
S I
os LS
Use of foetal doppler C S I
Spontaneous vaginal delivery LS S I
Microbiology
Collection of blood culture C I
Lumbar Puncture and measurement of CSF
C S I
opening pressure*
Paediatric non-invasive urine collection C S I
Collection of swabs C I
Nasopharyngeal aspirate collection C S I

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Procedures in Emergency Medicine

Category Level of mastery
PROCEDURE C = common in EM S = under direct supervision
* See Procedural Requirement on p.108 LS = life/limb/sight I = independent
saving
End TS1 End TS2 End TS3 End TS4
Otolaryngological
Removal of nasal foreign bodies C S I
Removal of aural foreign bodies C S I
Removal of laryngeal foreign bodies C S I
Nasal speculum insertion C I
Nasal cautery C S I
Anterior nasal packing* C, LS S I
Posterior nasal packing* LS S I
Aural toilet C S I
Aural wick insertion C S I
Ophthalmological
Removal of corneal foreign bodies* C S I
Direct ophthalmoscopy C I
Use of a slit lamp in the eye examination C S I
Tonometry C S I
Eye irrigation C, LS I
Application of an eye pad or shield C S I
Lateral canthotomy LS S I
Dental
Joint reduction: Temporo- mandibular joint C S I
Enlocation avulsed/extruded/intruded/ laterally
C S I
injured tooth
Temporary stabilisation of injured tooth C S I
Haemostasis following dental extraction C S I
Ultrasound
Focused Echocardiography in Life Support (FELS)* C S I
Performance of Focused Assessment with
C S I
Sonography for Trauma (FAST) or EFAST*
Pneumothorax / haemothorax detection* C S I
Detection & characterisation of an abdominal
C S I
aortic aneurysm*
Guided Peripheral Vascular Access C S I
Guided Central Vascular Access C S I
Ultrasound guided nerve blocks S I
Identification of distended bladder C S I
Toxicology/Toxinology
Pressure immobilisation Bandage C, LS I
Gastrointestinal decontamination
LS S I
Gastric decontamination, whole bowel irrigation.
Environmental
Basic warming and cooling techniques
C, LS S I
External methods, IV fluids
Advanced warming and cooling techniques LS S I

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Prioritisation and Decision Making

1. Prioritisation of Patient Management

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS1 Be able to:

1.1 Apply accepted clinical guidelines and algorithms to prioritise

treatment of a patient.
1.2 Prioritise the essential tasks in a medium complexity patient with low
acuity. SEP, SDL, ST WBA, ITA, FEx
1.3 Manage more than one task and more than one patient at a time,
with guidance.
1.4 Respond to a surge in patient presentations by altering work rate.

TS2 Be able to:

2.1 Prioritise the assessment and management of a patient using the

paucity of available information.
2.2 Prioritise essential tasks in any medium complexity patient.
2.3 Adapt workload priorities in response to deterioration in a patient’s
circumstances or condition. SEP, SDL, ST WBA, ITA, FEx
2.4 Simultaneously assess and manage multiple patients of any age with
simple presentations.
2.5 Respond to a surge in patient presentations by accepting
redeployment to different areas of the department.

TS3 Be able to:

3.1 Prioritise the assessment and management of a patient with a

critically acute presentation.
3.2 Prioritise the essential tasks in a high complexity patient.
3.3 Adapt workload priorities in response to changes in departmental
needs. SEP, SDL, ST WBA, ITA, FEx
3.4 Simultaneously assess and manage multiple patients of any age with
complex presentations.
3.5 Respond to a surge in patient presentations by reprioritising
workload.

TS4 Be able to:

4.1 Prioritise the essential tasks in a patient with a rare presentation.

4.2 Delegate specific tasks from their own workload appropriately,
according to departmental needs.
4.3 Simultaneously assess a critically ill or injured patient whilst
overseeing other patients in the ED. SEP, SDL, ST WBA, ITA, FEx
4.4 Recognise an acute and sustained disaster situation and activate the
appropriate organisational response.
4.5 Apply modified risk stratification and prioritisation processes during
patient surges and disasters.

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| Prioritisation and Decision Making |

2. Clinical Risk

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS1 Be able to:

1.1 Apply the triage process and risk stratification tools, with particular
regard to differences in these for children and older people, to
patients in the emergency setting.
1.2 Identify high-risk features in a clinical assessment that increase the
likelihood of a particular diagnosis.
1.3 Use a structured risk assessment tool or pathway, which is
appropriate for the presentation, to create an investigation plan and
to estimate the likelihood of a particular diagnosis.
1.4 Use a structured risk stratification tool or pathway to create a safe
treatment and disposition plan.
1.5 Apply understanding of the impact of social and cultural factors SEP, SDL, ST WBA, ITA, FEx
on clinical risk to the management of patients in the emergency
department.
1.6 Apply the principles of patient safety to work in the emergency
setting.
1.7 Identify high-risk events that increase the likelihood of an adverse
patient outcome.
1.8 Apply the principles of situational awareness to recognising cause
and effect of clinical events.
1.9 Apply the principles of barrier care, including aseptic and sterile
technique to minimise infectious risk.

TS2 Be able to:

2.1 Identify the human and departmental factors that may impact
patient care.
2.2 Apply understanding of common barriers to safe and timely decision
making by adapting behaviours to minimise the risk of error and
suboptimal care.
2.3 Identify and minimise risks associated with patient handover.
2.4 Recognise cause and effect of slowly evolving or predictable events
as they occur.
2.5 Manage the most immediate problem whilst remaining vigilant for
other potential problems. SEP, SDL, ST WBA, ITA, FEx
2.6 Integrate infection control principles into daily clinical practice.
2.7 Demonstrate understanding of common barriers to safe and timely
decision making.
2.8 Demonstrate understanding of human and departmental factors that
contribute to error and suboptimal patient care.
2.9 Demonstrate understanding of strategies that minimise the risk of
error and suboptimal care, including clinical handover.
2.10 Apply patient safety principles in the management of multiple
patients.

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| Prioritisation and Decision Making Clinical Risk |

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS3 Be able to:

3.1 Apply understanding of how human and departmental factors,

including institutional racism and unconscious bias, may contribute
to error and suboptimal patient care by adapting behaviours to
minimise risk of error and suboptimal care.
3.2 Use clinical acumen and understanding of specific statistical data to
individualise the risk assessment of a patient.
3.3 Recognise clinical handover as an opportunity to increase safety and
accuracy in decision making.
3.4 Anticipate and prepare for likely events in the near future.
3.5 Manage multiple problems simultaneously whilst remaining vigilant SEP, SDL, ST WBA, ITA, FEx
for other potential problems.
3.6 Filter crucial factors from the available information and recognise
when available information is incomplete.
3.7 Facilitate contact tracing and follow up conducted by external public
health authorities.
3.8 Demonstrate self-reflective practice when contemplating one’s own
implicit bias.
3.9 Use effective strategies to minimise the risk of error and suboptimal
care in patients in the emergency department

TS4 Be able to:

4.1 Use clinical acumen to estimate the level of risk to a patient who has
ceased their emergency care prematurely.
4.2 Advise colleagues on risk stratification processes applied to clinical
emergency medicine.
4.3 Anticipate and prepare for multiple potential problems.
4.4 Demonstrate continued situational awareness with increased task
loading.
SEP, SDL, ST WBA, ITA, FEx
4.5 Evaluate the integrity of the available information.
4.6 Contribute to the development of policy and procedures on infection
control and barrier care.
4.7 Develop and implement changes resulting from quality activities
associated with infection control.
4.8 Adapt infection control procedures to successfully manage disasters
and pandemics.

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| Prioritisation and Decision Making |

3. Decision making

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS1 Be able to:

1.1 Apply the principles of clinical and diagnostic reasoning in clinical

emergency medicine.
1.2 Apply a problem-solving approach to guide patient treatment.
1.3 Decide to initiate resuscitation when a patient is recognised as
critically ill or deteriorating.
1.4 Demonstrate an understanding that decisions must be made in order
to progress patient care.
1.5 Justify the decision to admit a patient with a simple presentation. SEP, SDL, ST WBA, ITA, FEx
1.6 Justify the decision to admit a patient with a medium complexity non-
critical presentation to a particular inpatient unit, based on a clear
diagnosis.
1.7 Decide to commence an appropriate clinical treatment pathway
matched to the patient presentation.
1.8 Make safe and timely decision for a simple patient presentation.
1.9 Justify the decision to discharge a patient with a simple presentation.

TS2 Demonstrate knowledge and understanding of:

2.1 The role of analytical thinking versus pattern recognition thinking in

SEP, SDL, ST ITA, FEx
clinical emergency medicine.

Be able to:

2.2 Apply the understanding of analytical thinking and pattern recognition

to decision making.
2.3 Use basic sciences to explain patient findings and treatment.
2.4 Incorporate patient and family/whānau needs as part of shared
decision-making.
2.5 Identify distinct moments in the patient journey where a decision
SEP, SDL, ST WBA, ITA, FEx
must be made in order to progress patient care.
2.6 Identify potential gaps in decision making.
2.7 Justify the decision to admit a patient with a non-complex
presentation to a critical care unit based on a clear diagnosis.
2.8 Justify the decision to discharge a patient with a medium complexity
presentation with a clear plan.

TS3 Demonstrate knowledge and understanding of:

3.1 Principles of decision-making styles, including type 1 and type 2

SEP, SDL, ST ITA, FEx
thinking.

Be able to:

3.2 Apply the cognitive steps in the clinical reasoning process and
understanding of causes of decision-making errors to patient
management in the emergency setting.
3.3 Incorporate input from colleagues to inform decisions.
SEP, SDL, ST WBA, ITA, FEx
3.4 Decide appropriately what treatment to commence when supplied
with incomplete and uncertain information.
3.5 Make safe and timely decision for a complex or critical patient
presentation.

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| Prioritisation and Decision Making Decision making |

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies
TS3 3.6 Facilitate early decision making by others to expedite patient care.
continued
3.7 Justify the decision to admit a patient with a high complexity
presentation to a particular inpatient unit, based on expected clinical SEP, SDL, ST WBA, ITA, FEx
course.
3.8 Logically explain the disposition decisions made.

TS4 Demonstrate knowledge and understanding of:

4.1 Conditions that promote optimal decision making in clinical

emergency medicine.
4.2 Common types of bias that may affect decision making.

Be able to:

4.3 Apply clinical reasoning to justify a decision that is made.

4.4 Reflect on the clinical reasoning process to clarify why a decision is
made and recognise decisions that lead to an error.
4.5 Explain the decision to limit assessment and treatment.
4.6 Decide to recruit specific additional staff and resources to initiate
time-critical patient care.
4.7 Justify own decisions as they occur and made timely corrections.
4.8 Review the decisions of others to seek and address situations where
either no decision or an incorrect decision has been made. SEP, SDL, ST WBA, ITA, FEx
4.9 Incorporate input from peers to inform shared decision-making for a
complex critical patient where there is no clear course of action.
4.10 Negotiate referral of a patient to multiple specialities.
4.11 Justify the decision to discharge a patient with a complex presentation
after a prolonged period of observation.
4.12 Justify the decision to transfer a patient to another health care facility.
4.13 Specify the resources that will be required to address ongoing post-
disposition needs, including allied health and psychosocial support.

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Communication

1. Principles of Effective Communication

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS1 Demonstrate knowledge and understanding of:

1.1 Common modifications used when communicating with specific

populations and cultures, including Aboriginal and Torres Strait eLM, ST ITA, FEx
Islander peoples and Māori.
Be able to:
1.2 Apply understanding of principles of good communication and active
listening to communication in practice.
1.3 Utilise opportunities, such as ward rounds, to optimise
communication across the multidisciplinary healthcare team.
1.4 Recognise how diversity in communication styles can impact upon
effective care.
1.5 Identify whether communicated information has been understood.
1.6 Consider the impact of health literacy to the exchange of information
in the clinical setting.
1.7 Identify barriers to effective verbal and non-verbal communication SEP, SDL, ST WBA, ITA, FEx
within the emergency medicine context, and their impact on effective
care.
1.8 Identify key aspects of communicating with patients who have
medical conditions that affect their ability to communicate.
1.9 Recognise factors that may cause information to be interpreted as
bad news by a patient or carer.
1.10 Recognise that the way bad news is delivered can have long term
effects on a patient or carer.
1.11 Recognise the value of having family/whanau or a support person
present to clarify information and aid understanding for a patient.
TS2 Be able to:
2.1 Demonstrate the ability to establish rapid rapport.
2.2 Interpret the non-verbal cues of others.
2.3 Identify the risks associated with ineffective communication.
2.4 Adapt communication style to minimise errors in patient assessment
and management.
2.5 Reach a negotiated understanding of the patient’s situation.
2.6 Identify strategies for assessing and improving health literacy.
2.7 Apply strategies to overcome communication barriers in the ED. SEP, SDL, ST WBA, ITA, FEx
2.8 Recruit and use additional resources to communicate with patients
with extra communication needs.
2.9 Work effectively with professional interpreters.
2.10 Prepare an appropriate environment to convey bad news.
2.11 Communicate bad news clearly, compassionately and sensitively to a
patient and/or carer and convey acceptance of their reaction.
2.12 Empathise with, show compassion and support a patient and/or carer
when conveying bad news.

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| Communication Principles of Effective Communication |

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS3 Be able to:

3.1 Tailor communication style to the needs of the individuals involved.

3.2 Display the use of verbal and non-verbal communication skills to
assist in the de-escalation of conflict.
3.3 Display the use of active listening to explore a patient’s concerns and
expectations.
3.4 Convey clear information about diagnosis, risk-benefit considerations,
and treatment options to a patient, tailored to their age, cultural
background and health literacy. SEP, SDL, ST WBA, ITA, FEx
3.5 Implement strategies for assessing and improving health literacy.
3.6 Apply understanding of diverse range of expressions of bereavement
and grief to the management of emotional reactions invoked when
conveying bad news.
3.7 Recognise when the patient and/or carer will require further
opportunities and support to fully comprehend the information
delivered.

TS4 Be able to:

4.1 Utilise a range of strategies that enhance effective communication

within the workplace.
4.2 Adapt communication effectively during complex and time critical
events.
4.3 Create a shared management plan.
SEP, SDL, ST WBA, ITA, FEx
4.4 Provide skills, advice and resources to junior doctors and other
members of the ED team in order to overcome communication
barriers and minimise risk to patient care.
4.5 Use a range of communication strategies to facilitate discussion of
sensitive issues with patients, families and other staff.

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| Communication |

2. Communication with Colleagues

Teaching
Training
Learning outcomes & Learning Assessment
Stages
Strategies

TS1 Be able to:

1.1 Create clear, accurate, legible and timely patient records.

1.2 Communicate effectively and compassionately with colleagues of
differing cultural background to oneself.
1.3 Use clinical notes to reflect the sequence of events during a patient
encounter.
1.4 Accurately convey the assessment findings, provisional diagnosis,
management plan, and reason for referral, when referring a patient to
a colleague for consultation, admission, or follow-up.
1.5 Apply structured referral techniques to effectively communicate to
colleagues and negotiate referral to multiple specialties.
1.6 Seek relevant information from colleagues and peers in the process of
patient assessment and delivery of care.
1.7 Record performance of procedures, including consent and
management of complications. SEP, SDL, ST WBA, ITA, FEx
1.8 Operate electronic patient management systems to update patient’s
management status regularly.
1.9 Demonstrate effective telephone communication skills.
1.10 Create a discharge or referral letter that summarises the current
patient episode and any outstanding issues.
1.11 Appropriately document handover of patient care.
1.12 Inform other team members of relevant patient care issues in a timely
fashion.
1.13 Summarise a patient’s assessment and management plan to another
team member.
1.14 Convey clinical information in a structured format during handover,
including transfer of unfinished assessment and management tasks.
1.15 Clarify outstanding tasks when receiving a handover.

TS2 Be able to:

2.1 Demonstrate effective use of electronic communication with primary

health clinicians and community health agencies.
2.2 Utilise a structured approach to communication regarding trauma
SEP, SDL, ST WBA, ITA, FEx
patients for handovers and referrals.
2.3 Produce succinct patient records and convey clinical reasoning when
documenting a patient encounter.

TS3 Be able to:

3.1 Ensure clear documentation of the purpose and findings of a

requested patient review.
3.2 Record advanced care orders, limitations of treatment and their
reasons.
3.3 Apply understanding of benefits and risks associated with electronic
SEP, SDL, ST WBA, ITA, FEx
patient management systems to the operation of these.
3.4 Write a concise discharge or referral letter that clearly outlines the
ongoing management issues for a patient with multiple and complex
post-discharge needs.
3.5 Appropriately document handover of patient care.

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| Communication Communication with Colleagues |

Teaching
Training
Learning outcomes & Learning Assessment
Stages
Strategies
TS3 3.6 Adapt communication skills to enhance the exchange of clinical
continued information with colleagues.
3.7 Accurately highlight the immediate care needs and management
priorities during referral.
3.8 Adapt communication style to ensure effective telemedicine SEP, SDL, ST WBA, ITA, FEx
communication and consultations.
3.9 Extract salient points relating to the patient’s care and present these
in a structured manner during handover.
3.10 Reassess and review management of the handover patient.

TS4 Be able to:

4.1 Write a concise and accurate summary of key issues in any patient’s
care.
4.2 Record concise clinical summaries that clarify patient care plans.
4.3 Support junior staff in writing effective discharge letters that highlight
key issues succinctly.
4.4 Apply the principles of appropriate, professional communication and
compassion when making a challenging referral to another specialist. SEP, SDL, ST WBA, ITA, FEx
4.5 Demonstrate effective communication skills when leading a
telemedicine consultation.
4.6 Ensure that outstanding tasks handed over are relevant to the current
emergency encounter.
4.7 Clarify and focus the clinical reasoning of the clinician providing
information during handover.

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| Communication |

3. Intercultural Communication

Teaching
Training
Learning outcomes & Learning Assessment
Stages
Strategies

TS1 Demonstrate knowledge and understanding of:

1.1 Principles of intercultural communication and culturally diverse

communication styles.
1.2 Understand the potential barriers to effective intercultural
communication that are specific to the ED.
1.3 Recognise one’s own culture and communication style as a health
SEP, SDL, ST WBA, ITA, FEx
practitioner.
1.4 Impact of cultural and linguistic differences on effective
communication and patient outcomes and how cultural differences in
communication styles can create misunderstandings.
1.5 Culturally diverse communication styles.

Be able to:

1.6 Apply principles of effective intercultural communication and

compassion to interactions with patients and colleagues.
1.7 Ask all patients about their ethnic or cultural identity in a safe
SEP, SDL, ST WBA, ITA, FEx
manner.
1.8 Recognise situations where working with a professional interpreter is
appropriate.

TS2 Demonstrate knowledge and understanding of:

2.1 Linguistic diversity, including Indigenous and language use. SEP, SDL, ST WBA, ITA, FEx

Be able to:

2.2 Recognise cultural influence on one’s own communication style.

2.3 Recognise cultural difference in non-verbal cues and symptom
expression.
2.4 Develop rapport with patients and their families from varied cultural
backgrounds.
SEP, SDL, ST WBA, ITA, FEx
2.5 Collaborate with Indigenous health care workers and other cultural
support staff to facilitate communication.
2.6 Modify communication style, as required, with patients of different
cultures.
2.7 Demonstrate ability to work effectively with professional interpreters.

TS3 Be able to:

3.1 Integrate intercultural knowledge into all communications within the

emergency medical setting.
3.2 Identify when cultural differences can lead to miscommunication
within the emergency medical setting.
SEP, SDL, ST WBA, ITA, FEx
3.3 Recognise culturally diverse communication styles and adapt
communication style appropriately.
3.4 Effectively negotiate the risks involved when required to communicate
through non-professional interpreters.

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| Communication |

4. Communication with Patients and Carers

Teaching
Training
Learning outcomes & Learning Assessment
Stages
Strategies

TS1 Be able to:

1.1 Elicit a thorough, relevant and accurate medical history.

1.2 Obtain collateral history from carers and witnesses.
1.3 Communicate the likely diagnosis and treatment plan to a patient.
1.4 Provide clear discharge information to a patient, including written
material where appropriate. SEP, SDL, ST WBA, ITA, FEx
1.5 Apply understanding of communication skills in children from
pre-verbal age to adolescence to the use of age-appropriate
communication strategies with paediatric patients.
1.6 Elicit the belief, wishes and expectations of a paediatric patient’s
parent(s) or carer(s).

TS2 Be able to:

2.1 Adapt communication style to align with a patient of any age.

2.2 Demonstrate compassion when communicating with the patient, their SEP, SDL, ST WBA, ITA, FEx
family/whānau and/or carers.

TS3 Be able to:

3.1 Elicit a history in a focused and timely manner, while acknowledging

the patient’s other expressed concerns.
3.2 Elicit the beliefs, wishes, expectations and concerns of the patient,
their family/whānau and/or carers, with regard to the patient’s
problem(s), diagnosis and treatment plan.
SEP, SDL, ST WBA, ITA, FEx
3.3 Convey clear information about diagnosis, risk/benefit considerations,
and treatment options to a paediatric patient and their parents and/
or carers.
3.4 Balance the communication needs of a paediatric patient with those
of their parent and/or carers.

TS4 Be able to:

4.1 Demonstrate effective communication with patients in any situation.

4.2 Adapt communication style to effectively engage a paediatric patient SEP, SDL, ST WBA, ITA, FEx
and their parents and/or carers.

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Teamwork & Collaboration

Teaching
Training
Learning outcomes & Learning Assessment
Stages
Strategies

TS1 Demonstrate knowledge and understanding of:

1.1 Features and benefits of good teamwork.

1.2 Scope of practice of all staff working in the ED, and prehospital health
care staff.
1.3 Risks for patient care and health care outcomes if inadequate
SEP, SDL, ST WBA, ITA, FEx
teamwork is not recognised or addressed.
1.4 Effective teamwork principles when assigned to a resuscitation team
role.
1.5 Role of each member of the multidisciplinary team.

Be able to:

1.6 Recognise and collaborate with the allocated medical team leader
during a shift in the ED.
1.7 Use the collective knowledge of fellow clinicians on duty to ensure
the creation of appropriate patient care plans.
1.8 Collaborate effectively with the multidisciplinary team during ward
rounds to optimise patient care.
1.9 Integrate the knowledge and skills of pre-hospital medical and
paramedical clinicians and other emergency services personnel to
optimise the care of emergency patients.
1.10 Actively collaborate with emergency allied health staff to enhance
patient care.
1.11 Undertake the role of team leader during an initial resuscitation with
the use of basic resuscitation skills until senior colleagues can assist.
1.12 Effectively communicate the need to activate a resuscitation team.
SEP, SDL, ST WBA, ITA, FEx
1.13 Effectively communicate that a patient has deteriorated.
1.14 Contribute to a resuscitation team’s information exchange.
1.15 Reflect on own performance and that of the team as a whole, with
guidance from the team leader.
1.16 Perform the necessary tasks in standard multidisciplinary clinical
pathways for appropriate patients.
1.17 Collaborate effectively with the patient’s primary health care provider
to ensure best outcomes in patient care.
1.18 Collaborate in a culturally appropriate way with Indigenous health
care workers and other cultural support staff to optimise cultural
safety.
1.19 Collaborate with patients and family/whānau members/carers to
create and enact patient management plans for the immediate
encounter.

TS2 Demonstrate knowledge and understanding of:

2.1 Effect of communication and personality on team performance. SEP, SDL, ST WBA, ITA, FEx

Be able to:

2.2 Integrate the knowledge and skills of other clinicians involved to

arrive at an optimal plan for patient care.
2.3 Incorporate the patient and other appropriate carers as team SEP, SDL, ST WBA, ITA, FEx
members when deciding and providing patient care.
2.4 Undertake a variety of resuscitation team roles.

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| Teamwork & Collaboration |

Teaching
Training
Learning outcomes & Learning Assessment
Stages
Strategies
2.5 Identify when other team members require assistance with their role
and communicate this to the team leader.
2.6 Utilise graded assertiveness to communicate patient safety issues to
the team leader.
2.7 Demonstrate flexibility and adaptive behaviours when working in a
team.
2.8 Undertake the role of team leader during a routine resuscitation
which responds to first line therapy.
2.9 Respond appropriately to questions asked by team members during a
resuscitation. SEP, SDL, ST WBA, ITA, FEx
2.10 Provide constructive feedback to other team members during a
debriefing.
2.11 Provide an appropriate referral to a member of the multidisciplinary
team.
2.12 Incorporate knowledge from non-emergency clinicians to refine the
differential diagnosis.
2.13 Show compassion when interacting and collaborating with colleagues.
2.14 Use a multidisciplinary approach to create clear ongoing patient care
plans with other hospital clinicians.

TS3 Demonstrate knowledge and understanding of:

3.1 Strategies for addressing ineffective teamwork in the ED. SEP, SDL, ST WBA, ITA, FEx

Be able to:

3.2 Integrate teamwork principles into daily practice relevant to optimal

care of individual patients.
3.3 Reflect on performance within a team for the purpose of ongoing
improvement.
3.4 Perform as a member of a well-functioning team with all other
clinicians in the immediate patient encounter.
3.5 Support the performance of other team members to produce optimal
teamwork.
3.6 Perform as a good team leader in a variety of ED settings.
3.7 Assemble effective clinical teams in different ED contexts.
3.8 Collaborate with other emergency medicine professionals for the
purposes of contributing to the creation of best practice guidelines.
3.9 Resolve conflict between ED team members to ensure ongoing SEP, SDL, ST WBA, ITA, FEx
optimal patient care.
3.10 Apply effective teamwork principles when working in teams of various
numbers and skill levels.
3.11 Allocate and brief a resuscitation team prior to the arrival of a critical
patient.
3.12 Undertake the role of team leader during a resuscitation which
requires more advanced therapeutics, such as in the case of a
paediatric patient.
3.13 Deliver pertinent, clear, concise and explicit instructions when giving
orders as a resuscitation team leader.
3.14 Seek verbal confirmation from team members to ensure instructions
are understood as a form of closed-loop communication.

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| Teamwork & Collaboration |

Teaching
Training
Learning outcomes & Learning Assessment
Stages
Strategies
TS3 3.15 Provide a clinical update to other medical staff without interrupting the
continued resuscitative efforts of the team.
3.16 Step in and out of the team leader role without disrupting the functioning
of the team as required.
3.17 Lead a team debrief after a straightforward resuscitation.
3.18 Prompt team members to provide constructive feedback during a
debriefing.
3.19 Communicate effectively with the healthcare team to ensure safe SEP, SDL, ST WBA, ITA, FEx
discharge.
3.20 Proactively access community services to aid in providing supportive care
in the community.
3.21 Resolve conflict between multidisciplinary teams to ensure ongoing
patient care.
3.22 Collaborate with patients and family/whānau/carers on issues of patient
care beyond the immediate clinical encounter.

TS4 Be able to:

4.1 Actively apply teamwork strategies to maintain optimal patient care
across the range of situations in the ED.
4.2 Identify gaps, anomalies and strategies to improve team processes and
functions.
4.3 Intervene when suboptimal teamwork is observed in order to minimise
errors in patient care.
4.4 Use immediate conflict resolution strategies to optimise teamwork.
4.5 Reflect upon overall team performance and promote processes which will
support ongoing improvement.
4.6 Provide support to fellow team members during and after the patient
encounter.
4.7 Provide immediate debriefing to team members when required.
4.8 Collaborate with other emergency medicine professionals for the
purposes of research, clinical governance, formal debriefing and formal
peer review.
4.9 Perform any resuscitation team role effectively, including team leader.
4.10 Lead resuscitation in any scenario.
4.11 Demonstrate a broad range of communication styles to confirm
SEP, SDL, ST WBA, ITA, FEx
leadership in a resuscitation team.
4.12 Employ active listening as a resuscitation team leader.
4.13 Provide positive messages to encourage their best performance.
4.14 Support junior staff in routine team leader roles.
4.15 Lead a team debrief after a complex resuscitation.
4.16 Recognise the need for additional resources to aid in debriefing,
particularly in highly emotional resuscitation scenarios.
4.17 Contribute to ongoing quality improvement as a result of a debriefing
session.
4.18 Contribute to improving hospital systems to support best patient care
through multidisciplinary collaboration.
4.19 Demonstrate skills to allow collaboration with clinicians outside
emergency medicine for interprofessional education.
4.20 Promote collaboration with Indigenous health care workers and other
cultural support staff to improve cultural safety through furthering
knowledge and respect of the cultural background of patients.
4.21 Collaborate with the family/whānau/carers, the patient, and the health
system to produce family/whānau-centred and patient-centred care.

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Leadership & Management

1. Roles and responsibilities in the emergency department

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS1 Demonstrate knowledge and understanding of:

1.1 Roles, functions, organisational structure and accountabilities of the

SEP, SDL, ST WBA, ITA, FEx
ED and its interdepartmental links.

Be able to:

1.2 Contribute effectively to one team role assigned by a supervisor or

lead clinician.
1.3 Seek help from a senior emergency clinician to perform the team
member role to guarantee best patient care. SEP, SDL, ST WBA, ITA, FEx
1.4 Demonstrate self-awareness, compassion and insight into own and
others’ competence and confidence when performing different team
roles.

TS2 Demonstrate knowledge and understanding of:

2.1 Reporting lines and direct line managers.

SEP, SDL, ST WBA, ITA, FEx
2.2 Purpose of different roles and clinical support tasks in an ED.

Be able to:

2.3 Take on different roles within a team during a patient encounter, and
SEP, SDL, ST WBA, ITA, FEx
during a shift.

TS3 Demonstrate knowledge and understanding of:

3.1 Effect of organisational structure on the delivery emergency health

care.
3.2 Gatekeeper role of the ED with respect to patient access to the health
SEP, SDL, ST WBA, ITA, FEx
care system.
3.3 Roles and responsibilities that represented managers perform in
different types of emergency departments and services.

Be able to:

3.4 Apply principles of good teamwork to ensure effective functioning as

a team member.
3.5 Proactively assist junior colleagues in the assessment and
SEP, SDL, ST WBA, ITA, FEx
management of their patients.
3.6 Demonstrate ability to alert a team leader to issues arising within the
department.

TS4 Be able to:

4.1 Effectively use the organisational structure of the workplace to deliver

emergency health care.
4.2 Identify different models of care used by difference emergency
SEP, SDL, ST WBA, ITA, FEx
departments and services.
4.3 Encourage, assist and promote effective teamwork with any clinician
who works with in the emergency setting.

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| Leadership & Management |

2. Human Resource Management

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS1 Demonstrate knowledge and understanding of:

1.1 How and why conflict occurs and its impact on patient care.
SEP, SDL, ST WBA, ITA, FEx
1.2 Strategies that prevent and resolve conflict.

TS2 Be able to:

2.1 Recognise signs of potential conflict.

2.2 Resolve conflict that arises with another colleague with assistance of
a third party. SEP, SDL, ST WBA, ITA, FEx
2.3 Identify the common challenges and stresses involved when
participating in shift work.

TS3 Be able to:

3.1 Recognise the importance of an approved process for reporting

conflict incidents to a supervisor.
3.2 Evaluate methods to prevent and/or resolve conflict escalation with
peer support. SEP, SDL, ST WBA, ITA, FEx
3.3 Apply basic strategies to manage conflict.
3.4 Identify potential strategies to minimise and eliminate risks
associated with providing a 24-hour service.

TS4 Be able to:

4.1 Resolve conflict between junior staff members in the workplace.

4.2 Show compassion and support junior medical staff and other
colleagues to manage and resolve conflict.
4.3 Negotiate an acceptable outcome to conflict, either individually or
through leading a team. SEP, SDL, ST WBA, ITA, FEx
4.4 Recognise and work through conflict with other staff members, and
between patients, families and staff.
4.5 Apply the principles of shift work, rolling rosters and industrial work
force requirements to ensure ongoing clinical cover.

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| Leadership & Management |

3. Operational Management of the ED and the Floor

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS1 Demonstrate knowledge and understanding of:

1.1 Concept and purpose of clinical supervision.

1.2 Components of the patient journey through the ED.
1.3 Purpose of departmental key performance indicators. SEP, SDL, ST WBA, ITA, FEx
1.4 Cumulative and relative costs for tests and treatments when
creating patient care plans.

Be able to:

1.5 Apply the use of triage systems in the ED to identifying patients

that should be managed in the resuscitation room.
1.6 Reflect on clinical practice to ascertain required level of clinical
SEP, SDL, ST WBA, ITA, FEx
supervision.
1.7 Reflect on clinical practice to improve the speed of processing a
patient.

TS2 Demonstrate knowledge and understanding of:

2.1 Departmental overcrowding and access block, and the effect of

these on patient care and clinical outcomes.
2.2 Utility and application of ED information systems and its role in
patient flow.
SEP, SDL, ST WBA, ITA, FEx
2.3 ‘Service gap’ as it applies to the ED.
2.4 Principles of change management.
2.5 Application of cost benefit analysis when developing definitive
management plans for patient care.

Be able to:

2.6 Function efficiently in clinical teams that follow prescribed

models of care.
2.7 Recognise the appropriate location within the ED for ongoing
care.
SEP, SDL, ST WBA, ITA, FEx
2.8 Apply understanding of different types of clinical supervision to
the oversight of the work of junior clinicians.
2.9 Collect data for key performance indicators.
2.10 Identify a service gap within the ED.

TS3 Demonstrate knowledge and understanding of:

3.1 The impact of ED design on the patient’s journey. SEP, SDL, ST WBA, ITA, FEx

Be able to:

3.2 Apply the principles of triage systems, including benefits and

limitations, to work in the ED.
3.3 Allocate patients according to clinical streaming principles.
3.4 Activate transfer of a patient to the resuscitation room.
3.5 Identify clinical management processes that can be used to SEP, SDL, ST WBA, ITA, FEx
streamline the patient’s journey through the ED.
3.6 Assist junior staff on more efficient patient processing.
3.7 Activate the hospital and/or ED escalation plan when
appropriate.
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| Leadership & Management Operational Management of the ED and the Floor |

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies
3.8 Adopt techniques used to manage patient surges.
3.9 Identify and report an underperforming staff member.
3.10 Analyse and review data obtained for key performance
indicators.
3.11 Explore possible solutions with senior staff for filling an
identified service gap.
SEP, SDL, ST WBA, ITA, FEx
3.12 Identify area and processes where departmental function can
be improved.
3.13 Demonstrate understanding of how change management can
effectively manage an introduction of a new policy or process.
3.14 Create and justify cost-effective testing and treatment plans
when performing patient care.

TS4 Demonstrate knowledge and understanding of:

4.1 Skills required of a departmental advocate for change within a

SEP, SDL, ST ITA, FEx
broader organisational change management project.

Be able to:

4.2 Manage the ED at times of patient surge.

4.3 Analyse and manage staffing allocations to improve patient flow.
4.4 Collaborate with other inpatient services to improve patient flow
during patient surges.
4.5 Use data on patient flow in the ED to improve patient care.
4.6 Demonstrate a variety of supervisory strategies during a
shift, including providing time-critical counselling for an SEP, SDL, ST ITA, FEx
underperforming junior staff member.
4.7 Make recommendations based on results obtained for key
performance indicators.
4.8 Outline the cost of health care to both the consumer and the
hospital.
4.9 Add elements of a business case when drafting a proposal for
change.

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| Leadership & Management |

4. Leadership in the emergency department

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS1 Demonstrate knowledge and understanding of:

1.1 Principles of management and leadership and the differences

SEP, SDL, ST ITA, FEx
between them.

Be able to:

1.2 Apply local media relation policies and refer enquiries appropriately. SEP, SDL, ST ITA, FEx

TS2 Demonstrate knowledge and understanding of:

2.1 Emotional intelligence and how it applies to clinical practice. SEP, SDL, ST ITA, FEx

TS3 Demonstrate knowledge and understanding of:

3.1 Management and leadership as these pertain to running a shift in the

SEP, SDL, ST ITA, FEx
ED.

Be able to:

3.2 Apply concepts of leadership to daily clinical practice.

3.3 Apply the knowledge and skills of being a good manager to daily
clinical practice.
3.4 Role model appropriate leadership behaviours to junior doctors.
3.5 Apply understanding of emotional intelligence to the management of
patients and families. SEP, SDL, ST WBA, ITA, FEx
3.6 Apply understanding of emotional intelligence to working in a team.
3.7 Demonstrate compassion towards self, colleagues, patients and
families.
3.8 Identify clinical situations which may trigger a media enquiry and
communicate this to senior clinicians.

TS4 Be able to:

4.1 Effectively lead the staff of an ED during a shift.

4.2 Participate in simple management tasks as directed by line manager.
4.3 Represent the ED and champion its priorities.
4.4 Role model and champion equity in the ED. SEP, SDL, ST WBA, ITA, FEx
4.5 Acknowledge and understand differences between personalities of
peers.
4.6 Create responses to media enquiries with the aid of standard hospital
communication processes.

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| Leadership & Management |

5. Mass Casualty Incidents and Disaster Management

Teaching
Training
Learning outcomes & Learning Assessment
Stages
Strategies

TS1 Demonstrate knowledge and understanding of:

1.1 The mass casualty incident. SEP, SDL, ST ITA, FEx

TS2 Demonstrate knowledge and understanding of:

2.1 Local policies for mass casualty incidents.

2.2 Impact of climate change on the provision of emergency medical
care, including the effects of the following on patient presentations
to ED:
(a) Severe weather changes
(b) Extreme heat SEP, SDL, ST ITA, FEx
(c) Air pollution
(d) Changes in vector ecology
(e) Increasing allergens
(f) Water quality impacts
(g) Water and food supply impacts

TS3 Be able to:

3.1 Participate in hospital escalation and exercises for mass casualty

incidents.
SEP, SDL, ST ITA, FEx
3.2 Articulate a strategy for selected use of diagnostic tests during a
mass casualty or disaster event.

TS4 Demonstrate knowledge and understanding of:

4.1 Occupational health and safety aspects of mass casualty incidents.

4.2 Role of clinical teams in the field during mass casualty incidents.
SEP, SDL, ST ITA, FEx
4.3 State and federal communication strategies during mass casualty
events and public health emergencies.

Be able to:

4.4 Manage the ED when a disaster code is activated, in collaboration

with local mass casualty incident managers.
4.5 Clearly communicate with external agencies involved in public health
responses, including police, local health department and other
SEP, SDL, ST ITA, FEx
relevant agencies.
4.6 Apply understanding of the impact of extreme weather events to
the management of patients in the ED, particularly during times of
patient surges.

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| Leadership & Management |

6. Patient Safety and Quality Management

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS1 Demonstrate understanding of:

1.1 Quality improvement activities and measures.

1.2 Incident reporting processes in the ED, hospital and roles of external
bodies in the review of significant incidents and sentinel events.
SEP, SDL, ST ITA, FEx
1.3 Incidents that require reporting.
1.4 Open disclosure.
1.5 Purpose of departmental morbidity and mortality reviews.

Be able to:

1.6 Participate in morbidity and mortality meetings.

1.7 Recognise errors in health care.
1.8 Provide feedback to the Director of emergency medicine on the SEP, SDL, ST ITA, FEx
operations of the ED from the perspective of a junior clinician.
1.9 Participate in collection of data for a Quality Improvement activity.

TS2 Demonstrate understanding of:

2.1 Factors that contribute to a culture of safety in the ED. SEP, SDL, ST ITA, FEx

Be able to:

2.2 Present a case at a morbidity and mortality meeting. SEP, SDL, ST ITA, FEx

TS3 Demonstrate understanding of:

3.1 Processes for reviewing errors and adverse events

3.2 Classification of types of reportable incidents
3.3 Types of risk reduction actions and activities SEP, SDL, ST ITA, FEx
3.4 Major national clinical data registers and reporting systems in
Australia and Aotearoa New Zealand

Be able to:

3.5 Participate in an ED quality review activity.

3.6 Independently write a workplace incident report.
3.7 Conduct a simple clinical audit.
SEP, SDL, ST WBA, ITA, FEx
3.8 Independently present a case at a morbidity and mortality meeting.
3.9 Implement recommendations from a morbidity and mortality
meeting.

TS4 Demonstrate understanding of:

4.1 Patient safety principles in the management of an ED.

4.2 Links between ED clinical governance and the provision of safe
quality care in the ED.
4.3 Quality management prescribed within the ACEM Quality Standards SEP, SDL, ST WBA, ITA, FEx
Framework.
4.4 Processes to monitor system changes to improve patient safety and
the associated accountability framework.

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| Leadership & Management Patient Safety and Quality Management |

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies
TS4
Be able to:
continued
4.5 Apply risk stratification and patient safety principles to the daily
clinical operations in an ED.
4.6 Design clinical audits to measure the impact of ethnicity, gender and
age on equity of access to care and health outcomes.
4.7 Make recommendations based on an audit analysis.
4.8 Manage the process of a departmental morbidity and mortality
meeting and its application in the quality cycle.
4.9 Contribute to the implementation of system changes to improve
SEP, SDL, ST WBA, ITA, FEx
patient care as a result of an investigation into sentinel patient care
event.
4.10 Lead a team to collect data for quality assurance, clinical audit and
other risk management activities.
4.11 Collate, analyse, and present audit data to peers.
4.12 Represent the ED in a hospital-wide quality improvement activity.
4.13 Instigate a review of a system error using a Root Cause Analysis
approach.

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| Leadership & Management |

7. Complaints

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS1 Be able to:

1.1 Demonstrate understanding of local regulations pertaining to

the patient’s code of rights.
1.2 Recognise the rights of patients, family/whānau members and
carers to make a complaint.
1.3 Demonstrate understanding of local patient complaints
SEP, SDL, ST ITA, FEx
procedure.
1.4 Proactively seek assistance in responding to requests for
statements regarding a complaint.
1.5 Provide timely, accurate written responses to complaints, with
assistance, when required.

TS2 Be able to:

2.1 Identify the root cause of a patient’s complaint.

2.2 Contribute to the creation of a written response to a complaint.
2.3 Field and refer a complaint to appropriate shift/department SEP, SDL, ST WBA, ITA, FEx
managers in real time.
2.4 Review own role in the episode that lead to the complaint and
respond appropriately, with assistance.

TS3 Be able to:

3.1 Recognise all factors likely to lead to complaints.

3.2 Mange simple patient complaints.
SEP, SDL, ST WBA, ITA, FEx
3.3 Provide evidence for case reports in response to an
investigation into patient care.

TS4 Be able to:

4.1 Apply principles of complaint management to responses to

complaints in a timely manner, including the compilation of SEP, SDL, ST WBA, ITA, FEx
case reports in response to an investigation into patient care.

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Health Advocacy

1. Principles of Health Advocacy

Teaching
Training
Learning outcomes & Learning Assessment
Stages
Strategies

TS1 Demonstrate knowledge and understanding of:

1.1 Socio-economic, organisation, geographical, psychological, and

cultural factors that influence the likelihood of a patient accessing
health care.
1.2 Differences between equity and equality as it relates to health care.
SEP, SDL, ST WBA, ITA, FEx
1.3 Factors that affect health literacy, and the impact of low health
literacy on clinical outcomes, in particular compliance and delayed
presentation to the ED.
1.4 Rationale for screening, immunisation and contact tracing.

Be able to:

1.5 Recognise the duty of the medical professional to act as a patient

advocate, and the role of health advocacy in the practice of
emergency medicine.
1.6 Identify local resources available to address barriers to accessing
health care. SEP, SDL, ST WBA, ITA, FEx
1.7 Deliver patient-centred care for adult patients.
1.8 Deliver family/whānau-centred care for paediatric patients.
1.9 Provide basic health promotion and immunisation when requested.

TS2 Demonstrate knowledge and understanding of:

2.1 Patient rights and consumer advocacy guidelines as they apply to

emergency medicine, including the right to refuse or vary treatment SEP, SDL, ST WBA, ITA, FEx
plans.

Be able to:

2.2 Utilise relevant allied health and patient support staff to address
barriers to accessing health care.
2.3 Identify the interaction between mental, physical and social well-
being in relation to health.
SEP, SDL, ST WBA, ITA, FEx
2.4 Opportunistically promote healthy lifestyle choices and provide
simple health promotion messages to all patients.
2.5 Contribute to the creation of management plans that include health
promotion for all ED patients.

TS3 Demonstrate knowledge and understanding of:

3.1 Use of illness and injury data. SEP, SDL, ST WBA, ITA, FEx

Be able to:

3.2 Balance patient autonomy with best clinical practice.

3.3 Advocate for the elimination of inequities for patients.
SEP, SDL, ST WBA, ITA, FEx
3.4 Use consumer advocacy resources to advise patients on issues
relating to emergency medicine.

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| Health Advocacy Principles of Health Advocacy |

Teaching
Training
Learning outcomes & Learning Assessment
Stages
Strategies
TS3 3.5 Proactively identify barriers to accessing health care with patients of
continued any age and develop tailored strategies to address these.
3.6 Create a management plan that addresses identified risk factors of
SEP, SDL, ST WBA, ITA, FEx
disease.
3.7 Systematically develop management plans that include health
promotion.

TS4 Be able to:

4.1 Exhibit health advocacy systematically when providing patient care.

4.2 Advocate systematically for improved access to health care in the ED
and the elimination of inequities for patients.
4.3 Screen patients in a focussed manner according to knowledge about
societal trends and current public health surveillance data.
SEP, SDL, ST WBA, ITA, FEx
4.4 Respond actively to common public health initiatives that impact
on emergency medicine, including pandemics and novel infectious
diseases.
4.5 Contribute to the creation of tailored management plans with a focus
on complex patients with recurrent presentations.

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| Health Advocacy |

2. Cultural awareness, competence and safety

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS1 Demonstrate knowledge and understanding of:

1.1 Cultural awareness, competence and safety.

1.2 Importance of understanding one’s own cultural views and
recognising implicit biases and privilege.
1.3 Importance of learning about Aboriginal, Torres Strait Islander and
Māori cultures.
1.4 Importance of learning about other cultures.
1.5 Diversity of languages, customs and values of patients and SEP, SDL, ST WBA, ITA, FEx
colleagues.
1.6 Effects of stereotyping people of other cultures.
1.7 The culture of emergency medicine and the hospital system.
1.8 Importance of culturally safe patient-centred care.
1.9 Potential power imbalance in the relationship between a doctor and
their patient, and impact upon quality of care.

Be able to:

1.10 Identify and utilise resources that are locally available for Indigenous
and culturally diverse patients in the ED.
SEP, SDL, ST WBA, ITA, FEx
1.11 Identify and liaise with Indigenous and culturally appropriate primary
health care services.

TS2 Demonstrate knowledge and understanding of:

2.1 The impact of a doctor’s own cultural background upon their

assessment and management of patients.
2.2 Elements of culture that impact upon the patients access to and use
of emergency departments.
SEP, SDL, ST WBA, ITA, FEx
2.3 Influence of cultural factors on expectations regarding illness,
emergency care and the health care system in general.
2.4 Cultural factors that might create conflicting priorities between
patient and clinician.

Be able to:

2.5 Reflect on own cultural identity, beliefs, values, behaviours and

communication styles.
2.6 Examine own biases and prejudices that may consciously or
unconsciously exist toward cultural differences and actively work SEP, SDL, ST WBA, ITA, FEx
towards transforming them.
2.7 Recognise the culturally diverse roles of family/whānau in decision
making and service utilisation.

TS3 Demonstrate knowledge and understanding of:

3.1 Impact of the ED culture on delivering patient-centred care. SEP, SDL, ST WBA, ITA, FEx

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| Health Advocacy Cultural awareness, competence and safety |

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies
TS3
Be able to:
continued
3.2 Display empathy, compassion and respect towards people from other
cultures.
3.3 Apply knowledge of cultural groups respectfully and without reliance
on stereotypes. SEP, SDL, ST WBA, ITA, FEx
3.4 Tailor emergency care to the specific cultural needs of the patient.
3.5 Compensate the power imbalances inherent in the doctor-patient
relationship.

TS4 Be able to:

4.1 Care for patients of any cultural background without prejudice,

assumptions or judgement of cultural differences and with
compassion and respect to culturally-mediated priorities and choices.
4.2 Advocate for the delivery of culturally safe emergency care.
SEP, SDL, ST WBA, ITA, FEx
4.3 Challenge individual and systemic forms of discrimination within the
ED and health care service.
4.4 Advocate for the provision of appropriate resources for culturally
diverse patients with the ED, hospital and community.

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| Health Advocacy |

3. Advocacy for Vulnerable Patients

Vulnerable patients includes patients who are vulnerable due to factors such as age, impairment or disability,
poor health literacy, living arrangements, and adverse social determinants of health including LGBTQI+.

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS1 Demonstrate knowledge and understanding of:

1.1 Principles of health screening, including the risk factors for common
SEP, SDL, ST WBA, ITA, FEx
illnesses and injuries, addiction, abuse, neglect and violence.

Be able to:

1.2 Recognise patients who are vulnerable due to factors such as age,
impairment and/or disability, poor health literacy, exposure to
adverse social determinants of health.
1.3 Recognise vulnerable patients and the factors that lead patients to SEP, SDL, ST WBA, ITA, FEx
use the ED as their primary method of accessing health care.
1.4 Recognise the need for more complex management plans for
vulnerable patients, and the support required to develop these.

TS2 Be able to:

2.1 Routinely screen for recognised risk factors, including addiction,

abuse, neglect and violence, in patients presenting with common
illnesses and injuries.
2.2 Initiate emergency care, advice and referral for patients in whom
screening identifies risk factors. SEP, SDL, ST WBA, ITA, FEx
2.3 Identify and utilise resources that are locally available for vulnerable
patients in the ED.
2.4 The social, historical, ethical and political contexts relevant to the
delivery of health services for clients with substance use disorders

TS3 Be able to:

3.1 Tailor emergency care and disposition decisions to account for the
presence of vulnerability factors in patients of any age.
3.2 Integrate emergency care with the involvement of appropriate
SEP, SDL, ST WBA, ITA, FEx
support services to provide holistic care to a vulnerable patient.
3.3 Apply additional management strategies when patients are identified
with extra vulnerability risk factors.

TS4 Be able to:

4.1 Advocate for the provision of appropriate resources for vulnerable

SEP, SDL, ST WBA, ITA, FEx
patients within the ED, hospital and community.

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4. Indigenous health

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS1 Demonstrate knowledge and understanding of:

1.1 Diversity of ways that Indigenous peoples self-identify.

1.2 The historical and ongoing effects of colonisation on Aboriginal,
Torres Strait Islander peoples and Māori and its specific impacts
on health and wellbeing through the loss of language, culture, SEP, SDL, ST,
WBA, ITA, FEx
ancestral lands, displacement, homelessness, unemployment/loss of eLM
resources, and increased interaction with the justice system.
1.3 ACEM’s Reconciliation Action Plan and Te Rautaki Manaaki Mana:
Excellence in Emergency Care for Māori.

Be able to:

1.4 Recognise an Indigenous person as someone who identifies

themselves as Indigenous and is accepted as Indigenous by their
community.
1.5 Recognise the regional diversity of Indigenous language, cultures and
customs. SEP, SDL, ST,
WBA, ITA, FEx
1.6 Recognise, respect and utilise resources that are locally available for eLM
Indigenous patients, including Indigenous liaison officers and local
Indigenous primary health care services.
1.7 Recognise the health disparities commonly experienced by the
Indigenous populations of Australia and Aotearoa New Zealand.

TS2 Demonstrate knowledge and understanding of:

2.1 Common characteristics of Indigenous populations, including self-

identification as a distinct cultural group, historical continuity with
pre-colonial societies, nature of kinship in Indigenous communities,
strong links to ancestral territories and non-dominant status in
Australia and Aotearoa New Zealand.
2.2 Importance of working with patients’ families, including appreciating
variations in roles and responsibilities in relation to health.
2.3 Social and political history of the Indigenous populations of Australia
and Aotearoa New Zealand, and their impact on Indigenous access to,
perceptions and use of emergency care.
SEP, SDL, ST,
2.4 Indigenous peoples’ concepts of health and wellness, and the role of WBA, ITA, FEx
eLM
Indigenous traditional healing practices and medicines.
2.5 Prevalence of chronic disease in Indigenous populations and the
effects of increased disease burden on Indigenous communicates.
2.6 The role of culturally safe community health services in providing
timely and appropriate follow-up.
2.7 Application of the Section 100 and Close the Gap scheme for
pharmaceutical access for Aboriginal and Torres Strait Islander
patients.
2.8 Challenges of interpreting biomedical terminology into Indigenous
languages.

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| Health Advocacy Indigenous health |

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS3 Demonstrate knowledge and understanding of:

3.1 Socio-economic and colonial context that contributes to health

disparities within Indigenous populations. SEP, SDL, ST,
WBA, ITA, FEx
3.2 Perceptions of waiting times in Indigenous communities, and the eLM
prevalence and reasons for Take Own Leave.

Be able to:

3.3 Incorporate knowledge of medical conditions known to affect local

Indigenous populations disproportionately when formulating a
diagnosis for an Indigenous patient.
3.4 Integrate emergency care with the involvement of appropriate
SEP, SDL, ST,
Indigenous hospital and local community support services to provide WBA, ITA, FEx
eLM
holistic care for an Indigenous patient.
3.5 Recognise patients at risk of Take Own Leave, and utilise strategies to
minimise Take Own Leave, including effectively negotiating a patient-
accepted management plan.

TS4 Be able to:

4.1 Incorporate ACEM’s Reconciliation Action Plan and Te Rautaki

Manaaki Mana: Excellence in Emergency Care for Māori into practice.
4.2 Advocate for and support the provision of appropriate resources for SEP, SDL, ST,
WBA, ITA, FEx
Indigenous patients in the ED, hospital and community. eLM
4.3 Support sustained relationship with external organisations to
improve the delivery of health care to Indigenous patients.

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| Health Advocacy |

5. Refugee health

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS1 Demonstrate knowledge and understanding of:

1.1 Situations that may lead people to seek asylum or refugee status in
Australia and Aotearoa New Zealand.
1.1 Cultural, experiential and political factors that impact on refugee,
asylum seeker and migrant access to, perceptions and use of SEP, SDL, ST WBA, ITA, FEx
emergency care.
1.2 Prevalence of Female Genital Mutilation and its impact on women’s
gynaecological health.

TS2 Demonstrate knowledge and understanding of:

2.1 Health disparities commonly experienced by people who seek asylum

or refugee status.
2.2 Impact of trauma and torture on the ongoing psychological
and physical health of refugees and asylum seekers and the SEP, SDL, ST WBA, ITA, FEx
consequences for ED care.
2.3 Context of pre-arrival health care and health issues relevant to ED of
newly arrived migrants, refugees and asylum seekers.

Be able to:

2.4 Enquire sensitively about refugee status, including experiences of

trauma or torture, as appropriate to a patient’s emergency problem.
2.5 Sensitively manage and refer patients with ongoing psychological and
physical sequelae from torture and trauma. SEP, SDL, ST WBA, ITA, FEx
2.6 Instigate management and appropriate referral for newly arrived
migrant and refugee patients presenting with common health
complaints.

TS3 Be able to:

3.1 Apply understanding of medical conditions known to affect refugee

populations disproportionately when formulating a diagnosis for a
refugee patient.
SEP, SDL, ST WBA, ITA, FEx
3.2 Integrate emergency care with the involvement of appropriate refugee
support services to provide holistic and compassionate care for a
refugee patient.

TS4 Be able to:

4.1 Promote and sustain relationships with external organisations to

improve the delivery of health care to refugee and asylum seeker SEP, SDL, ST WBA, ITA, FEx
patients.

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| Health Advocacy |

6. End of Life Care

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS1 Demonstrate knowledge and understanding of:

1.1 Culturally diverse patients’ understanding of palliative care, including

experience of pain and pain management, and cultural factors and
beliefs that impact upon end-of-life decision making.
1.2 Diversity of cultural expressions of grief and important cultural rituals
and protocols following a death in the ED. SEP, SDL, ST WBA, ITA, FEx
1.3 Circumstances that may lead to a dying patient being managed in the
ED.
1.4 The ED not being the ideal environment in which to manage a dying
patient.

Be able to:

1.5 Demonstrate compassion towards patients and their family/whānau

and/or carers when discussing and providing end of life care.
1.6 Locate existing previous information about a patient’s functional
status and their expressed goals and wishes regarding medical
treatment.
SEP, SDL, ST WBA, ITA, FEx
1.7 Document end of life decisions clearly in the medical record.
1.8 Advocate for the provision of an appropriate environment for a
patient who is dying in the ED.
1.9 Identify a patient as a potential organ donor according to recognised
medical criteria.

TS2 Demonstrate knowledge and understanding of:

2.1 Medically non-beneficial treatment.

SEP, SDL, ST WBA, ITA, FEx
2.2 Clinical situations where end of life care must be discussed.

Be able to:

2.3 Initiate discussion in the ED with a patient and their family/whānau

and/or carers about their values, goals and wishes regarding medical
treatment.
2.4 Advocate for a patient by initiating discussion regarding end of life
care with inpatient clinicians and community health professionals.
2.5 Identify and utilise resources that are locally available for a patient
SEP, SDL, ST WBA, ITA, FEx
who is dying in the ED.
2.6 Work effectively with Indigenous and other culturally diverse families
following the death of a patient in the ED, taking into consideration
relevant cultural factors.
2.7 Notify the organ donation service and inpatient critical care clinicians
appropriately.

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| Health Advocacy End of Life Care |

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS3 Be able to:

3.1 Assess the impact of an acute illness or injury on the chronic state
of a patient and identify where the goals of emergency care should
become palliative.
3.2 Record discussions and decisions about end of life care clearly in the
medical record.
3.3 Advocate by communicating the expressed wishes of a patient and
their family/whānau and/or carers regarding medical treatment to
the inpatient clinicians. SEP, SDL, ST WBA, ITA, FEx
3.4 Complete the required notifications and documentation after a death
in the ED.
3.5 Take responsibility for ceasing resuscitation appropriately in a simple
presentation.
3.6 Manage dyspnoea and pain in the dying patient.
3.7 Facilitate the provision of cultural and spiritual support to the dying
patient and their family/whānau/carers.

TS4 Be able to:

4.1 Recognise resuscitation presentations where ongoing resuscitation

may be non-beneficial.
4.2 Limit monitoring and investigations appropriate where the goals of
emergency care are palliative.
4.3 Explain the decisions regarding medical management and the goals
of end of life care to a patient and their family/whānau and/or
carers.
4.4 Lead the discussion with patients and their family/whānau and/or
carers regarding the medical decisions and goals for end of life care.
4.5 Advocate by liaising with inpatient clinicians and community health SEP, SDL, ST WBA, ITA, FEx
professionals to promote holistic end of life care.
4.6 Take responsibility for ceasing resuscitation appropriately in a
complex presentation.
4.7 Decide on appropriate goals of care and limitation of medical
treatment for a dying patient.
4.8 Deliver appropriate end of care palliative care to a patient who is
dying in the ED.
4.9 Sensitively elicit patient and carer wishes regarding organ donation
where appropriate in the ED.

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Scholarship & Teaching

1. Critically Appraising and Applying the Evidence

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS1 Demonstrate knowledge and understanding of:

1.1 The role and limitations of evidence-based medicine as it applies to

SEP, SDL, ST ITA, RR, FEx
emergency medicine practice.

Be able to:

1.2 Locate academic medical information in an educational environment.

1.3 Locate written and electronic medical information in the workplace to
inform emergency medicine practice.
WBA, ITA, RR,
1.4 Locate, integrate and modify as required local and regional guidelines SEP, SDL, ST
FEx
to patient care plans for emergency medicine presentations.
1.5 Integrate academic reading with sentinel workplace events to improve
their emergency medicine practice.

TS2 Be able to:

2.1 Select appropriate medical information that could inform emergency

medicine practice.
2.2 Critically appraise the evidence that informed published standards,
guidelines, or core clinical protocols for applicability to local
emergency medicine practice.
2.3 Critically appraise a published article with quantitative and
qualitative data to address a clinical question, with the support of a
template. WBA, ITA, RR,
SEP, SDL, ST
2.4 Assess the validity of a study, taking into consideration potential FEx
confounders and biases.
2.5 Assess the significance of the results of a study, taking into account
its magnitude and applicability to patients under consideration.
2.6 Describe the role of publication bias in influencing literature
published in the emergency medicine context.
2.7 Modify the application of standard clinical guidelines to a patient’s
presentation, with the aid of senior medical staff.

TS3 Demonstrate knowledge and understanding of:

3.1 Clinical relevance of a published article as applied to emergency

medicine practice. WBA, ITA, RR,
SEP, SDL, ST
3.2 Design concepts which enhance or detract from the relevance of FEx
published literature as applied to emergency medicine.

Be able to:

3.3 Independently search for information to perform a limited literature

review to define and justify standards of clinical practice.
3.4 Locate appropriate published literature to support clinical decisions.
WBA, ITA, RR,
3.5 Evaluate quoted quantitative statistical results to validate findings in SEP, SDL, ST
FEx
a published clinical article.
3.6 Critically appraise, without the use of a template, a published article
with quantitative data.

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| Scholarship & Teaching Critically Appraising and Applying the Evidence |

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies
TS3 3.7 Critically appraise and compare clinical guidelines in the context of
continued emergency medicine.
3.8 Modify application of standard clinical guidelines after incorporating
critically appraised, newly published research and according to the
patient’s presentation. WBA, ITA, RR,
SEP, SDL, ST
3.9 Evaluate a broad range of academic reading, including newly FEx
published research, to improve their emergency medicine practice
with the aid of senior medical staff.
3.10 Highlight deficiencies in research study results that suggest further
scholarly enquiry is warranted.

TS4 Be able to:

4.1 Regularly search for a range of literature relevant to emergency

medicine.
4.2 Review the results acquired from a literature review for effectiveness
and relevance in local emergency medicine practice.
4.3 Critically appraise a published article with qualitative data, with
the use of a template, by assessing the validity of a study, potential
confounders and biases
4.4 significance of the results, taking into account its magnitude and
applicability to patients under consideration. WBA, ITA, RR,
SEP, SDL, ST
FEx
4.5 Critically appraise the evidence that informed a published standard
or guideline for applicability to local emergency medicine practice.
4.6 Combine critically appraised literature and local expert practice to
amend a local clinical guideline or protocol.
4.7 Participate in the evaluation and revision of clinical protocols and
guidelines as applied to emergency medicine practice.
4.8 Systematically integrate broad academic reading with self-reflection
to improve their emergency medicine practice.

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| Scholarship & Teaching |

2. Research Methodology

Demonstrate knowledge of research methodology and apply this to evidence-based practice of emergency
medicine.

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS1 Demonstrate knowledge and understanding of:

1.1 Role of research in maintaining and advancing clinical best practice

RR
in emergency medicine. RR
FEx
1.2 Referencing standards applied to academic literature.

Be able to:

1.3 Identify areas of practice where research is merited.

1.4 Determine appropriate research question in a range of contexts
appropriate for emergency medicine.
RR
1.5 Identify potential research participants and demonstrate a willingness RR
FEx
to recruit patients for active research studies.
1.6 Apply ethics and participation management principles and adhere to
local regulations in recruitment of participants into research studies.

TS2 Demonstrate knowledge and understanding of:

2.1 The role of ethics submission and approval in the creation of clinical
research in an emergency medicine context. RR
RR
2.2 The role of informed consent in the recruitment of participants for FEx
clinical research.

TS3 Demonstrate knowledge and understanding of:

3.1 Common statistical terms, summary statistics and statistical tests

used for data analysis, including sensitivity, specificity, positive
predictive value, negative predictive value, accuracy, relative risk,
odds ratio and other likelihood ratios, confidence intervals, number
needed to treat, statistical significance, mean, median, standard
deviation, pre- and post-test probability.
3.2 Statistical tests, including ANOVA, t-tests, Mann Witney U test, chi
squared test.
3.3 Measurements of disease frequency and association, including:
(a) Prevalence, incidence, cumulative incidence
(b) Incidence rates, age-specific rates
3.4 Various research methodologies and levels of evidence, including: RR
RR
(a) Experimental FEx
(b) Observational
(c) Meta-analysis
(d) Case series and reports
(e) Literature reviews
(f) Multi-centre trials
(g) Quantitative vs qualitative vs quasi-qualitative
3.5 Basic principles of medical research design, including sample size,
randomisation and blinding, bias, validity, hypothesis formulation,
superiority study, non-inferiority study.
3.6 Principles of participation management in research studies
conducted in the workplace.

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| Scholarship & Teaching Research Methodology |

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies
TS3
Be able to:
continued
3.7 Combine critically appraised literature and local expert practice in the
evaluation of local clinical guidelines.
3.8 Match research methodology to question appropriate across the
breadth of emergency medicine practice. RR
RR
3.9 Appropriately analyse and critique research design. FEx

3.10 Apply the principles of privacy, confidentiality, ethics, consent and

disclosure of information to a clinical research project conducted in
an emergency medicine context.

TS4 Be able to:

4.1 Write about a clinical topic or practice in simple academic style.

4.2 Apply the principles of research and referencing to write an evidence-
RR
based article. RR
FEx
4.3 Advocate for appropriate clinical research to be conducted in
emergency departments.

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| Scholarship & Teaching |

3. Learning in Emergency Medicine

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS1 Be able to:

1.1 Develop and document a personalised education plan, in

consultation with an allocated supervisor, to maintain consistent and
continual development of knowledge and skills.
1.2 Identify learning points arising from seeing patients in the ED.
1.3 Utilise learning activities and resources aligned to own learning style
to optimise learning and improve clinical practice.
1.4 Regularly participate in performance review to demonstrate self-
reflection and focus future learning.
1.5 Actively seek and act on formal and informal feedback from SDL, ST ITA, FEx
experienced colleagues, including feedback received from workplace-
based assessments, asking question to clarify relevant points.
1.6 Utilise feedback from assessment to enhance self-assessment and
focus future learning.
1.7 Utilise the available range of patient presentations in the ED as an
opportunity to increase clinical experience and learning.
1.8 Apply understanding of benefits and limitations of simulation
medicine to the use of this to develop emergency medicine skills.

TS2 Be able to:

2.1 Identify and prioritise strengths and weaknesses in current level of

practice by conducting regular needs analyses.
2.2 Utilise ward rounds to observe and learn from the skills of senior
clinicians, or to obtain feedback on own performance.
2.3 Integrate knowledge and skills gained from supervisors to improve
SDL, ST ITA, FEx
clinical expertise.
2.4 Identify key communication principles for delivering effective
immediate and formal feedback.
2.5 Utilise simulation medicine to enhance the development of
teamwork, communication skills and maintaining patient safety.

TS3 Be able to:

3.1 Independently develop a learning plan to complete emergency

medicine training.
3.2 Apply other learning styles to enhance study of emergency medicine.
3.3 Evaluate and reflect on significant personal clinical experiences to
develop new knowledge and skill in emergency medicine.
3.4 Identify learning points from any experiences during a shift that will SDL, ST WBA, ITA, FEx
enhance emergency medicine practice.
3.5 Integrate learning points arising from all patients seen during the
shift.
3.6 Actively seek opportunities to improve practice through workplace-
based assessments.

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| Scholarship & Teaching Learning in Emergency Medicine |

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS4 Be able to:

4.1 Independently develop a learning plan to facilitate continuing

professional development.
4.2 Identify cases that could be used as teaching and learning
opportunities.
4.3 Demonstrate the ability to participate in simulation of any fidelity as SDL, ST ITA, FEx
if in clinical practice.
4.4 Routinely critically appraise own total practice through self-reflection
and self-assessment to demonstrate growth as a professional
emergency medicine Physician.

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| Scholarship & Teaching |

4. Teaching in Emergency Medicine

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS1 Be able to:

1.1 Identify a patient presentation as an appropriate case for teaching

emergency medicine to prevocational clinicians.
1.2 Present a case or topic to a small audience as a teaching activity for
pre-vocational clinicians, utilising a diverse range of visual, auditory
and electronic aids to facilitate learning.
1.3 Facilitate bed-side teaching to prevocational clinicians.
1.4 Deliver bed-side teaching of basic procedural skills to prevocational
clinicians, while maintaining awareness of and sensitivity to the SDL, ST ITA, FEx
patient.
1.5 Describe good features of observed constructive feedback when
delivered by senior colleagues.
1.6 Deliver positive feedback to colleagues to reinforce good emergency
medicine practice.
1.7 Demonstrate understanding of the purpose and components of
formal appraisal.

TS2 Be able to:

2.1 Integrate basic principles of adult learning to proficiently deliver a

teaching session to a small audience.
2.2 Engage in opportunistic bed-side teaching whenever the potential
arises, as appropriate.
SDL, ST ITA, FEx
2.3 Apply a structured approach to deliver constructive feedback to
junior medical staff about emergency medicine practice.
2.4 Contribute information, when requested, for a formal appraisal of
junior staff.

TS3 Be able to:

3.1 Appropriately match a teaching method to the audience and subject

matter.
3.2 Integrate basic adult learning principles to enhance the delivery of
clinical bed-side teaching. SDL, ST ITA, FEx
3.3 Deliver constructive feedback to junior medical staff and peers.
3.4 Advise which domains need to be addressed in a formal appraisal
process for junior staff and associated strategies.

TS4 Be able to:

4.1 Lead a case presentation and follow-up discussion with fellow

clinicians.
4.2 Effectively teach procedural skills and the use of equipment.
4.3 Integrate simulation aids when delivering teaching as appropriate.
SDL, ST ITA, FEx
4.4 Proactively utilise identified teaching opportunities in the ED.
4.5 Deliver appropriately timed feedback to members of the ED team
based on opportunities arising in the ED.
4.6 Perform a formal appraisal of a junior clinician.

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Professionalism

1. Professional Conduct and its Regulation

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS1 Be able to:

1.1 Identify the key skills and attributes associated with the professional
conduct of medical staff.
1.2 Behave professionally when performing clinical duties.
1.3 Maintain registrations with appropriate medical regulatory agencies
and professional organisations. SDL, ST ITA, FEx
1.4 Adhere to College and professional standards as an emergency
medicine clinician including the demonstration of knowledge of
ACEM training policies and regulations, and the organisational and
management skills needed to meet all training program requirements.

TS2 Demonstrate knowledge and understanding of:

2.1 Role and function of national medical regulatory agencies and

SDL, ST ITA, FEx
professional organisations.

Be able to:

2.2 Apply professional codes of conduct to other duties and research

performed in emergency medicine.
2.3 Behave professionally performing all duties within emergency
SDL, ST ITA, FEx
medicine.
2.4 Represent self and colleagues as professional emergency medicine
clinicians to the general public.

TS3 Demonstrate knowledge and understanding of:

3.1 Principles of managing professional misconduct. SDL, ST ITA, FEx

Be able to:

3.2 Apply professional codes of conduct to examples of behaviour

observed in the workplace. SDL, ST ITA, FEx
3.3 Identify and refer incidents of misconduct to senior medical staff.

TS4 Demonstrate knowledge and understanding of:

4.1 Role and function of medical regulatory agencies in addressing

SDL, ST ITA, FEx
misconduct.

Be able to:

4.2 Proactively support and encourage colleagues to comply with medical

regulations.
4.3 Maintain competence and current practice.
4.4 Provide clear and effective information about the role of emergency SDL, ST ITA, FEx
medicine to the general public.
4.5 Provide society with a positive perception of emergency medicine
clinicians through own professional behaviour.

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| Professionalism |

2. Ethics and Medicolegal Frameworks in Emergency Medicine

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS1 Demonstrate knowledge and understanding of:

1.1 Principles of valid informed consent, presumed consent, and capacity

to make informed decisions.
1.2 National codes of ethics. SDL, ST WBA, ITA, FEx
1.3 Obligations and principles of legal documents of national significance
to emergency medicine, such as Te Tiriti O Waitangi,

Be able to:

1.4 Adhere to applicable ethical and medico-legal frameworks in

emergency medicine practice.
1.5 Obtain informed consent from patients for simple interventions.
1.6 Identify patients with limited or no capacity to make informed
decision about their medical treatment.
1.7 Complete mandatory reporting requirements in simple situations.
1.8 Write medico-legal reports on patients, with assistance.
1.9 Seek advice from senior medical staff to resolve ethical dilemmas.
SEP, SDL, ST WBA, ITA, FEx
1.10 Demonstrate understanding of the purpose and format of a police or
coronial report.
1.11 Present evidence in court after pre-review by senior clinicians.
1.12 Identify mandatory reporting requirements for emergency medicine.
1.13 Provide equitable, non-discriminatory and compassionate care to all
patients.
1.14 Apply principles of patient confidentiality to practice and
documentation.

TS2 Demonstrate knowledge and understanding of:

2.1 Application of medico-legal frameworks to:

(a) Duty of care
(b) Competency
(c) Mental health
(d) Child protection
(e) Notifiable diseases
(f) Occupational health and safety
2.2 Ethical principles in emergency medicine practice, including: SEP, SDL, ST WBA, ITA, FEx
(a) Autonomy
(b) Beneficence
(c) Non-Maleficence
(d) Distributive Justice
(e) Futility
(f) Dignity
(g) Honesty

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| Professionalism Ethics and Medicolegal Frameworks in Emergency Medicine |

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies
TS2
continued Be able to:
2.3 Obtain informed consent from patients for complex interventions.
2.4 Recognise situations in which the use of presumed consent is
appropriate.
2.5 Write a medico-legal report autonomously and submit it for review.
2.6 Complete accurate police statements. SEP, SDL, ST WBA, ITA, FEx
2.7 Identify situations in which principles of confidentiality may differ
across cultural groups.
2.8 Recognise situations that put patient confidentiality at risk and act to
prevent loss of confidentiality.

TS3 Demonstrate knowledge and understanding of:

3.1 Medico-legal Acts that govern clinical emergency medicine practice.

3.2 Application of medico-legal frameworks to life-threatening situations
and death, guardianship and medical power of attorney, and consent SEP, SDL, ST WBA, ITA, FEx
to treatment.
3.3 Processes for the collection and maintenance of forensic evidence.

Be able to:

3.4 Obtain informed consent from patients for life-saving procedures in

critical situations.
3.5 Recognise situations in which the provision of treatment without the
informed consent of the patient, next of kin, person responsible or
legal guardian is appropriate.
3.6 Create an accurate notification report to the coroner.
SEP, SDL, ST WBA, ITA, FEx
3.7 Identify conflicts of interest in emergency medicine practice.
3.8 Recognise and act upon complex ethical dilemmas arising at work.
3.9 Recognise situations when it is necessary to breach patient
confidentiality and act accordingly.
3.10 Recognise situations in which the complexities of patient-centred
care may require external ethical or legal opinion.

TS4 Demonstrate knowledge and understanding of:

4.1 Legal and ethical obligations of clinicians when caring for a patient
without the capacity to make informed decisions.
4.2 Application of medico-legal frameworks to natural justice and
procedural fairness in relation to patient complaints and clinical
supervision. SEP, SDL, ST WBA, ITA, FEx
4.3 Processes for coronial and government reviews, in cases of individual
patients and in the event of a disaster or mass casualty incident.
4.4 Ethical and legal principles of sharing clinical information with
colleagues.

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| Professionalism Ethics and Medicolegal Frameworks in Emergency Medicine |

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies
TS4
continued Be able to:
4.5 Obtain informed consent from patients for complex and high-risk
interventions.
4.6 Provide care for patients without the capacity to make informed
decisions. SEP, SDL, ST WBA, ITA, FEx
4.7 Identify and communicate with the correct person for decision
making when caring for a patient without the capacity to make
informed decisions.
4.8 Critique examples of medico-legal reports and revise as needed.
4.9 Present a summary of recommendations from medico-legal reports
to a forum of peers to identify potential improvements in service
delivery.
4.10 Complete mandatory reporting requirements in any circumstances.
4.11 Appropriately manage conflicts of interest in emergency medicine
practice.
4.12 Balance ethics, culture, patient autonomy and clinical needs to create SEP, SDL, ST WBA, ITA, FEx
optimal patient care.
4.13 Communicate with team members to clarify and move forward from
complex ethical dilemmas arising from conflicting professionalism
and clinical judgements.
4.14 Apply strategies to address risk factors in patient confidentiality.
4.15 Justify resolution of conflicts between legal and ethical care,
evidence-based medicine and presumed best practice in delivering
patient care.

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| Professionalism |

3. Responsibility to Profession and Self

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies

TS1 Demonstrate knowledge and understanding of:

1.1 Burnout and stress, and factors in the practice of emergency medicine
that may contribute to these. SEP, SDL, ST ITA, FEx
1.2 Role of ACEM in training and regulating emergency medicine.

Be able to:

1.3 Address own learning needs through the support of a mentor.

1.4 Provide appropriate support and assistance to peers, supporting
others to grow and develop, and offer feedback in an appropriate
manner.
1.5 Build and maintain supportive professional relationships.
1.6 Modify clinical practice and self-care behaviours as a result of
feedback received. SEP, SDL, ST ITA, FEx
1.7 Recognise own responses to experiences in the ED, such as situations
of violence, abuse, illness, suffering and trauma.
1.8 Recognise the challenges of working with diverse and vulnerable
patients in emergency contexts.
1.9 Proactively seek assistance from mentors, peers and senior staff to
prioritise and organise an appropriate work-life balance.

TS2 Demonstrate knowledge and understanding of:

2.1 Principles of effective mentoring to support the ongoing performance

SEP, SDL, ST ITA, FEx
of medical colleagues.

Be able to:

2.2 Engage in peer mentoring relationships in order to develop own and

others’ practice.
2.3 Recognise situations where professional relationships may be
compromised.
2.4 Utilise basic strategies to aid in the maintenance of professional
relationships in more challenging situations.
2.5 Use guided reflection to analyse own clinical practice, conduct and
attitude.
2.6 Reflect, with guidance, on own responses to experiences in the ED
SEP, SDL, ST ITA, FEx
that evoke strong emotional reactions, such as death, dying and grief.
2.7 Determine strategies to monitor emotional reactions and seek
assistance when necessary.
2.8 Identify signs and symptoms of impaired ability in self and proactively
seek the assistance of mentors, senior staff, or support personnel as
appropriate.
2.9 Identify opportunities to participate in ACEM activities and processes.
2.10 Reflect on work-life balance and implement protective mechanisms
to maintain a balance.

TS3 Demonstrate knowledge and understanding of:

3.1 Policies, procedures and support services available for medical

SEP, SDL, ST ITA, FEx
practitioners.

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| Professionalism Responsibility to Profession and Self |

Teaching
Training
Learning outcomes & Learning Assessment
Stage
Strategies
TS3
Be able to:
continued
3.2 Demonstrate effective mentorship techniques.
3.3 Use a range of feedback, listening and questioning techniques to
constructively challenge the mentee and facilitate insight.
3.4 Provide clear and effective information about the role of emergency
medicine to peers, colleagues and other medical specialities.
3.5 Independently analyse own clinical practice, conduct and attitude,
and put in place corrective strategies to modify behaviour when
necessary.
3.6 Proactively seek support for dealing with responses to challenging SEP, SDL, ST ITA, FEx
experiences.
3.7 Utilise strategies to respond to the challenges of working with
vulnerable patients in emergency contexts.
3.8 Identify signs and symptoms of burnout and stress.
3.9 Identify signs and symptoms of troubled or impaired medical staff
and refer to senior medical staff appropriately.
3.10 Balance contributing to ACEM activities with maintaining progression
in own training and work-life balance.

TS4 Be able to:

4.1 Adapt mentorship techniques in response to the mentee’s needs,

stage of development and situation.
4.2 Reflect, review and seek feedback on own mentoring skills in order to
improve mentoring practice.
4.3 Role model and advocate for the Emergency medicine profession
through own professional standards.
4.4 Utilise advanced strategies to aid in the maintenance of professional
relationships in more challenging situations.
4.5 Continually analyse own standards of practice, clinical decisions and
professional behaviour.
4.6 Routinely participate in continuing professional development.
4.7 Maintain awareness of own response to experiences in the ED and
employ a variety of strategies for dealing with those responses.
SEP, SDL, ST ITA, FEx
4.8 Identify and implement strategies to assist junior staff in dealing with
challenging workplace situations.
4.9 Identify and refer clinicians to disciplinary processes in relation to
medical malpractice.
4.10 Provide immediate support to the impaired clinician in order to
maintain patient safety.
4.11 Monitor professional competence and currency of junior medical staff.
4.12 Contribute and feed back to ACEM about its role and support to its
members and the specialty of Emergency medicine.
4.13 Systematically prioritise and organise an appropriate work-life
balance, integrating mechanisms to protect against burnout.
4.14 Promote values of work-life balance to mentees and junior clinicians.
4.15 Consider opportunities for diversifying future career progression.

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5. Rural & Regional Emergency Medicine Practice

The rural emergency medicine context, especially the reduced local availability of physical and human resources,
mandate important adaptations. Care is provided by smaller teams, typically with generalist clinical capabilities,
and in tight-knit communities. Distance to specialist centres and reduced inpatient services increases the
time that emergency physicians at smaller hospitals are responsible for complex patients both in and beyond
the emergency department. Isolated professional practice requires rural and remote emergency physicians to
accurately assess their skills and scope of practise without the benefit of easily accessible peer consultation.

In addition to preparing a trainee for practice as a specialist in a rural or remote location, a trainee may benefit
from rural and remote experience in three clinical situations:

1. Clinical situations occurring predominantly in rural and remote departments.

An example is administering thrombolytics for acute myocardial infarction in hospitals more than 90
minutes from a percutaneous coronary intervention facility.

2. Clinical situations occurring in most types of department, but where

the approach is often different in a rural or remote location
An example is assessing a complex ophthalmological problem without onsite specialist assistance. Although
all emergency physicians care for patients when access to vital resources is difficult or delayed, rural and
remote emergency physicians manage problems where the recommended onsite resources do not exist. As
these situations occur often and for many types of presentation, rural and remote emergency physicians
develop decision-making processes that evaluate when less advanced diagnostic modalities are acceptable,
and when patients can be observed in lieu of complex investigations. Understanding these approaches can
help trainees from all emergency settings clarify their thinking about rational use of investigations, as well
as help them consider obstacles faced by rural clinicians when transferring patients from rural to urban
emergency departments.

3. Clinical situations that occur in many types of department, but where a rural location provides
more opportunities for independent experience and longitudinal provision of care.
Procedures at tertiary emergency departments may be shared between many emergency trainees or may be
performed by inpatient specialty units. Junior trainees in rural departments may benefit from the smaller
ratio of trainees to emergency physicians. Senior trainees may benefit from situations where they are the
most senior doctor on-site, not only in the emergency department but in in-patient wards, where their
emergency medicine expertise can be applied to the longitudinal provision of care to patients.

Teaching
Learning outcomes & Learning Assessment
Strategies

Demonstrate knowledge and understanding of rural and regional emergency medicine practice:

1 The variety of contexts in which emergency medicine is practiced, including

variation due to increasing remoteness and decreased hospital size.
2 Epidemiology, as pertains to rural emergency medicine practice, including:
(a) Envenomation
(b) Chemical exposure in agricultural and mining industries
(c) High speed road trauma and animal-related trauma
(d) Zoonoses and unusual infections
3 Relative health of rural and remote communities compared to urban SEP, ST WBA, ITA, FEx
communities.
4 Injury prevention in rural areas, including prevention of workplace injuries in
farming families.
5 Impact of distance of patients from the hospital on patient management.
6 Development of safe ED discharge arrangements for patients with ongoing
acute medical complains.
7 Family/whānau disruption due to hospital admission and transfer to urban
centres.
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| 5. Rural & Regional Emergency Medicine Practice |

Teaching
Learning outcomes & Learning Assessment
Strategies
8 The impact of distance from specialty and subspecialty resources on:
(a) Rational use of clinical investigations and observation in lieu of
transport for investigation
(b) Conservative treatment of problems where advance treatments of
complications are not available locally
SEP, ST WBA, ITA, FEx
9 Options available to transfer a patient to a facility with specialist expertise,
including hospital bypass, inter-hospital transport systems, and networking
of regional hospitals.
10 Options available to bring expertise to the patient through telemedicine
modalities and associated clinical techniques.

Be able to:

Provision of emergency clinical care in a rural setting

1 Demonstrate resourceful independent practice when working in geographic
and professional isolation.
2 Demonstrate strategies to provide effective and timely clinical care when
away from onsite access to specialist medical, diagnostic and allied health
services.
3 Demonstrate effective reasoning when assessing risk in rural and regional
settings, including balancing the risk of disease progression or need for
specialty consult, with the risk of transfer.
4 Provide effective and timely clinical care when away from ready access to
first-line modalities like interventional radiology and percutaneous coronary
intervention. SEP, ST WBA, ITA, FEx
5 Harness the resources available in the health care team, the local
community and family/whānau to optimise delivery of care close to home.
6 Work flexibly in the rural hospital environment, apply emergency medicine
expertise to optimisation of patient care in the emergency department and
in inpatient wards.
7 Recognise the importance of and contribute to the continuity of patient care.
8 Use information and communication technology, including telemedicine,
to provide medical care or facilitate access to specialised care for patients
when onsite advice is not available.
9 Use information and communication technology to network and exchange
information with distant colleagues.

Referral and Transfer

1 Develop and utilise advanced pre-hospital medical expertise in order to
provide effective sustained care for critical care patients in situations of
prolonged wait for retrieval.
2 Arrange referral to distant services in collaboration with the patient and/or
carer(s), considering the balance of potential benefits, harms and costs.
3 Anticipate and judiciously arrange safe patient transfer within own facility SEP, ST WBA, ITA, FEx
and to other facilities, considering clinical indications, available resources,
service capabilities, patient preferences, transportation, geography and
distance.
4 Ensure adequate prehospital and ED cover when transporting a critically ill
patient.
5 Communicate effectively at a distance with consulting or receiving clinical
personnel.

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| 5. Rural & Regional Emergency Medicine Practice |

Teaching
Learning outcomes & Learning Assessment
Strategies

Teamwork and Collaboration

1 Demonstrate abilities to promote, enhance and foster strong relationships
between the emergency medicine specialist and rural generalist workforce,
extended-practice nurses, and rural paramedics.
2 Work effectively as part of the rural hospital multidisciplinary team.
3 Provide direct and distant clinical support for other rural and remote health
care personnel. SEP, ST WBA, ITA, FEx
4 Establish a peer support network and utilise this network to debrief in times
of stress
5 Identify opportunities to network and build relationships with metropolitan
emergency medicine colleagues, other specialists and stakeholders to
overcome the divide between rural, regional and metropolitan emergency
departments, and to enhance access to equal health care for the rural and
regional communities.

Leadership and Management

1 Apply understanding of different models of care commonly used in rural
and regional emergency departments and Emergency Services to the
provision of effective emergency medical care.
SEP, ST WBA, ITA, FEx
2 Implement effective conflict resolution strategies in small and/or isolated
teams.
3 Provide inter-professional team leadership in emergency care that includes
quality assurance.

Health Advocacy
1 Describe examples of how a service gap is related to gaps in the whole
health system and how this affects patient care.
2 Understand the avenues for advocacy for appropriate resource allocation
and utilisation in rural regional centres.
3 Encouraging rural communities to access emergency care in an early and SEP, ST WBA, ITA, FEx
appropriate manner.
4 Respect local community norms and values in own life and work practices,
with an appreciation of community expectations and challenges, such as
confidentiality in small communities.
5 Identify and acquire knowledge and skills as may be required to meet health
care needs of the local population.

Scholarship and Teaching

1 Identify and utilise means and resources to maintain one’s own professional
skills and knowledge in an isolated environment
2 Identify educational needs specific to the rural environment SEP, ST WBA, ITA, FEx
3 Support junior doctors and other health care professionals for a career in
rural emergency medicine
4 Develop and deliver teaching sessions tailored to a rural workforce, the rural
working environment & community needs.

Professionalism
1 Demonstrate well developed capacity for self-reflection and ready SEP, ST WBA, ITA, FEx
identification of own limitations in practice, particularly in settings of
relative professional isolation.

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6. Recommended resources

As part of self-directed learning, trainees may access reference texts to facilitate the development of their
knowledge and skills to apply to daily practice and in preparation for examinations. It is emphasised that the
Primary and Fellowship Examinations are aimed at assessing trainees’ knowledge of subject matter, not the
capacity to memorise textbooks.

Although careful consideration of the texts available has led to the recommendation of some texts as core
references for the subject, it is acknowledged that no single text addresses the entire knowledge base required
for the practice of emergency medicine.

The most recent edition of the following texts should be used. If the most recent edition has been available for
less than 12 months, the previous edition may also be used.

6.1 Foundations of Emergency Medicine

Anatomy
+ K.L. Moore, A.F. Dalley, A.M.R. Agur. Clinically Oriented Anatomy. Lippincott Williams & Wilkins.
+ P. Abrahams, J. Spratt, M. Loukas, A.N. van Schoor. McMinn and Abrahams’ Clinical Atlas of Human Anatomy.
Mosby Ltd.
+ Anatomedia, https://anatomedia.com
Pathology
+ V. Kumar, A. Abbas, J. Aster. Robbins and Cotran Pathologic Basis of Disease. Elsevier.
Physiology
+ K.E. Barrett, S.M. Barman, H.L. Brooks, J.X.-J. Yuan. Ganong Review of Medical Physiology. McGraw Hill.
+ J.B. West, A.M. Luks. West’s Respiratory Physiology: The Essentials. Wolters Kluwer.
Pharmacology
+ B.G. Katzung, A.J. Trevor, K. Basic and Clinical Pharmacology. McGraw Hill.
+ B. Knollman, B.A. Chabner, L. Brunton. Goodman and Gilman’s The Pharmacological Basis of Therapeutics.
McGraw Hill.

6.2 Clinical Management in Emergency Medicine

+ P. Cameron, M. Little, B. Mitra, C. Deasy (eds.). Textbook of Adult Emergency Medicine. Elsevier.
+ R.J. Dunn, M. Borland, D. O’Brien. The Emergency Medicine Manual. Venom Publishing.
+ J.E. Tintinalli (ed.). Emergency Medicine: A Comprehensive Study Guide. McGraw Hill.
+ R. Hockberger, M. Gausche-Hill, R. Walls. Rosen’s Emergency Medicine: Concepts and Clinical Practice. Elsevier.
+ P. Cameron, G. Browne, B. Mitra, S. Dalziel, S. Craig. Textbook of Paediatric Emergency Medicine. Elsevier.
+ J.R. Roberts. Roberts and Hedges’ Clinical Procedures in Emergency Medicine and Acute Care. Elsevier.

6.3 Additional Clinical Texts

+ T.C. Chan, W.J. Brady, R.A. Harrigan. ECG in Emergency Medicine and Acute Care. Elsevier.
+ L. Murray, M. Little, O. Pascu, K.A. Hoggett. Toxicology Handbook. Elsevier.
+ A.D. Bernsten, J.M. Handy. Oh’s Intensive Care Manual. Elsevier.
+ N.J. Talley, S. O’Connor. Examination Medicine: A Guide to Physician Training. Churchill Livingstone.
+ G. Q. Sharieff, M McCollough. Neonatal and Infant Emergencies. Cambridge University Press.
+ P. Croskerry, K.S. Cosby. Patient Safety in Emergency Medicine. LWW.

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| 6. Recommended resources |

6.4 Journals
In addition to the texts listed above, the following journals regularly include articles relevant to emergency
medicine.

+ Emergency Medicine Australasia, Wiley-Blackwell, Australasia.

+ Annals of Emergency Medicine, Elsevier, USA.
+ Journal of Emergency Medicine, Elsevier, USA.
+ Academic Emergency Medicine, Wiley, USA.
+ British Medical Journal, BMJ, United Kingdom.
+ Emergency Medicine Journal, BMJ, United Kingdom.
+ Medical Journal of Australia, Wiley, Australia.
+ New England Journal of Medicine, Massachusetts Medical Society, USA.
+ Circulation, Lippincott Williams & Wilkins, USA.
+ Lancet, Elsevier, United Kingdom.
+ Journal of Trauma, Lippincott Williams & Wilkins, USA.

6.5 ACEM Educational Resources

Trainees are encouraged to review the resources available on the ACEM Educational Resources website: https://
elearning.acem.org.au/

6.6 ACEM-endorsed Standards, Statements and Guidelines

All ACEM-endorsed standards, statement, policies and guidelines align with at least one of the three entrustable
areas of emergency medicine practice: patient care, departmental function, and career longevity. These
documents are available on the ACEM website: https://acem.org.au/Search-Pages/Policy-And-Regulation-Search,
and include, but are not limited to, the following:

+ COR235 Code of Conduct

+ COR139 Conflict of Interest Policy
+ S18 Statement on Responsibility for Care in Emergency Departments
+ P28 Policy on a Quality Framework for Emergency Departments
+ P53 Policy on the Supervision of Junior Medical Staff in the ED
+ P55 Policy on the Components of an Emergency Medicine Consultation
+ COR133 Discrimination, Bullying and Sexual Harassment Policy
+ COR656 Procedures for Submission and Resolution of Complaint

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Australasian College for Emergency Medicine
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West Melbourne VIC 3003
Australia
+61 3 9320 0444
[email protected]

acem.org.au