ACRRM Primary Curriculum 3rd Edition 25-09-09 With Cover

Third Edition
Level 4, 410 Queen Street

Brisbane Q 4000
email: acrrm@acrrm.org.au
website: www.acrrm.org.au
phone: +61 7 3105 8200
fax: +61 7 3105 8299
Primary Curriculum
Third Edition
Revised 2009
Editor
Dr Tom Doolan
Contact Details
Australian College of Rural and Remote Medicine
GPO Box 2507
BRISBANE QLD 4001
Telephone 07 3105 8200 Email acrrm@acrrm.org.au

Fax 07 3105 8299 Website www.acrrm.org.au
ISSN
ISSN 1447-1051
Copyright
© Australian College of Rural and Remote Medicine 2009. All rights reserved. No part of this document may be
reproduced by any means or in any form without express permission in writing from the Australian College of Rural
and Remote Medicine.
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ACRRM PRIMARY CURRICULUM – THIRD EDITION
Table of Contents Page
1.0 INTRODUCTION 7
1.1 Defining Rural and Remote General Practice ……………………………………………………………………………………… 7
1.2 Target Group…………………………………… ……………………………………………………………………………………… 7
1.3 Background...…………………………………… ……………………………………………………………………………………… 7
1.4 Rationale – Why is Rural and Remote General Practice Important? …………………………………………………………...... 8
2.0 CURRICULUM 11
2.1 Aim ………………………………………………………………………………………………………………………………………. 11
2.2 Purpose …………………………………………………………………………………………………………………………………. 11
2.3 Curriculum Model ………………………………………………………………………………………………………………………. 11
2.4 Principles ………………………………………………………………………………………………………………………………... 12
2.5 Learning Outcomes ………………………………………………………………………………….................................................13
2.5.1 Domain 1 – Core Clinical Knowledge and Skills …………………………………………………………………………………………… 14
2.5.2 Domain 2 – Extended Clinical Practice …………………………………………………………………………………………………….. 15
2.5.3 Domain 3 – Emergency Care ………………………………………………………………………………………………………………… 16
2.5.4 Domain 4 – Population Health …………………..…………………………………………………………………………………………… 17
2.5.5 Domain 5 – Aboriginal and Torres Strait Islander Health.………………………………………………………………………………… 18
2.5.6 Domain 6 – Professional, Legal and Ethical Practice……………………………………………………………………………………… 20
2.5.7 Domain 7 – Rural and Remote Context ………..…………………………………………………………………………………………... 21
2.6 Curriculum Statements ………………………………………………………………………………………………………………... 22
3.0 IMPLEMENTATION 24
3.1 ACRRM Training Standards ………………………………………………………………………………………………………….. 24
3.2 ACRRM Training Pathways …………………………………………………………………………………………………………… 24
3.3 Duration of Training ……………………………………………………………………………………………………………………. 25
3.4 Teaching and Learning Methods ………………………………………………………………………………………………………26
3.5 Teacher’s Roles ………………………………………………………………………………………………………………………… 27
3.6 The RRMEO Education Management Platform……………………………………………………………………………………… 28
3.7 Essential Resources …………………………………………………………………………………………………………………… 28
4.0 ASSESSMENT 29
4.1 Programmatic Assessment Model …………………………………………………………………………………………………… 29
4.2 Assessment Principles ………………………………………………………………………………………………………………… 29
4.3 Assessment Framework ……………………………………………………………………………………………………………….. 30
4.3.1 Formative Assessment ……………………………………………………………………………………………………………………….. 30
4.3.2 Summative Assessment ……………………………………………………………………………………………………………………… 31
4.4 Descriptions of Assessment Methods………………………………………………………………………………………………… 31
4.4.1 MCQ Examination ……………………………………………………………………………………………………………………………. 31
4.4.2 StAMPS Examination ………………………………………………………………………………………………………………………… 31
4.4.3 Procedural Skills Log Book ……………………………………………………..…………………………………………………………… 32
4.4.4 Portfolio ………………………………………………………………………………………………………………………………………… 32
4.4.5 Multi Source Feedback ………………………………………………………………………………………………………………………. 33
4.4.6 Mini CEX ………………………………………………………………………………………………………………………………………. 33
4.5 Assessment Blueprint ………………………………………………………………………………………………………………….. 34
5.0 EVALUATION 39
6.0 CURRICULUM STATEMENTS 40
6.1 Aboriginal and Torres Strait Islander Health………………………………………………………………………………………… 41
6.1.1 Context …………………………………………………………………………………………………………………………………….. 41
6.1.2 Learning Objectives ………………………………………………………………………………………………………………………. 41
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6.1.3 Content Online ……………………………………………………………………………………………………………………………. 41
6.1.4 Content …………………………………………………………………………………………………………………………………….. 41
6.1.5 Source Document ………………………………………………………………………………………………………………………… 48
6.1.6 Acknowledgements ………………………………………………………………………………………………………………………. 48
6.2 Adult Internal Medicine ………………………………………………………………………………………………......................... 51
6.2.1 Context …………………………………………………………………………………………………………………………………….. 51
6.2.3 Content Online ……………………………………………………………………………………………………………………………. 51
6.2.4 Content …………………………………………………………………………………………………………………………………….. 52
6.2.5 Acknowledgements ……………………………………………………………………………………………………………………….. 85
6.3 Aged Care……………………………………………………………………………………………………………………………….. 86
6.3.1 Context …………………………………………………………………………………………………………………………………….. 86
6.3.3 Content Online ……………………………………………………………………………………………………………………………. 86
6.3.4 Content …………………………………………………………………………………………………………………………………….. 86
6.4 Anaesthetics…………………………………………………………………………………………………………………………….. 93
6.4.1 Context …………………………………………………………………………………………………………………………………….. 93
6.4.3 Content Online ……………………………………………………………………………………………………………………………. 93
6.4.4 Content …………………………………………………………………………………………………………………………………….. 93
6.5 Child and Adolescent Health………………………………………………………………………………………………………….. 99
6.5.1 Context …………………………………………………………………………………………………………………………………….. 99
6.5.3 Content Online ……………………………………………………………………………………………………………………………. 100
6.5.4 Content …………………………………………………………………………………………………………………………………….. 100
6.5.5 Teaching & Learning Methods ………………………………………………………………………………………………………….. 115
6.5.6 Notes for Teachers & Registrars ……………………………………………………………………………………………………….. 116
6.5.7 Bibliography ……………………………………………………………………………………………………………………………….. 117
6.5.8 Recommended Texts & Resources …………………………………………………………………………………………………….. 117
6.6 Dermatology…………………………………………………………………………………………………………………………….. 119
6.6.1 Context …………………………………………………………………………………………………………………………………….. 119
6.6.2 Background ……………………………………………………………………………………………………………………………….. 119
6.6.4 Content Online ……………………………………………………………………………………………………………………………. 119
6.6.5 Content …………………………………………………………………………………………………………………………………….. 119
6.7 Emergency Medicine………………………………………………………………………………………………………………….. 126
6.7.1 Context …………………………………………………………………………………………………………………………………….. 126
6.7.2 Background ……………………………………………………………………………………………………………………………….. 126
6.7.4 Content Online ……………………………………………………………………………………………………………………………. 127
6.7.5 Content …………………………………………………………………………………………………………………………………….. 127
6.8 Information Technology / Information Management……………………………………………………………………………….. 137
6.8.1 Context …………………………………………………………………………………………………………………………………….. 137
6.8.3 Content Online ……………………………………………………………………………………………………………………………. 137
6.8.4 Content …………………………………………………………………………………………………………………………………….. 137
6.9 Management…………………………………………………………………………………………………………………………….. 143
6.9.1 Context …………………………………………………………………………………………………………………………………….. 143
6.9.2 Background ……………………………………………………………………………………………………………………………….. 143
6.9.4 Content Online ……………………………………………………………………………………………………………………………. 144
6.9.5 Content …………………………………………………………………………………………………………………………………….. 144
6.10 Musculoskeletal Medicine…………………………………………………………………………………………………………….. 152
6.10.1 Context …………………………………………………………………………………………………………………………………….. 152
6.10.2 Background ………………………………………………………………………………………………………………………………… 152
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6.10.4 Content Online ……………………………………………………………………………………………………………………………. 153
6.10.5 Content …………………………………………………………………………………………………………………………………….. 153
6.10.6 Teaching & Learning Methods ………………………………………………………………………………………………………….. 170
6.10.7 Resources/Readings …………………………………………………………………………………………………………………….. 170
6.11 Obstetrics / Women’s Health………………………………………………………………………………………………………….. 172
6.11.1 Context …………………………………………………………………………………………………………………………………….. 172
6.11.3 Content Online ……………………………………………………………………………………………………………………………. 172
6.11.4 Content …………………………………………………………………………………………………………………………………….. 172
6.12 Office-based General Practice……………………………………………………………………………………………………….. 182
6.12.1 Context …………………………………………………………………………………………………………………………………….. 182
6.12.2 Background ……………………………………………………………………………………………………………………………….. 182
6.12.4 Content Online ……………………………………………………………………………………………………………………………. 182
6.12.5 Content …………………………………………………………………………………………………………………………………….. 183
6.12.6 References ………………………………………………………………………………………………………………………………… 186
6.13 Ophthalmology………………………………………………………………………………………………………………………….. 188
6.13.1 Context …………………………………………………………………………………………………………………………………….. 188
6.13.3 Content Online ……………………………………………………………………………………………………………………………. 188
6.13.4 Content …………………………………………………………………………………………………………………………………….. 188
6.14 Oral Health……………………...……………………………………………………………………………………………………….. 195
6.14.1 Context …………………………………………………………………………………………………………………………………….. 195
6.14.3 Content Online ……………………………………………………………………………………………………………………………. 195
6.14.4 Content …………………………………………………………………………………………………………………………………….. 195
6.15 Palliative Medicine….…………………………………………………………………………………………………………………… 199
6.15.1 Context …………………………………………………………………………………………………………………………………….. 199
6.15.3 Content Online ……………………………………………………………………………………………………………………………. 199
6.15.4 Content …………………………………………………………………………………………………………………………………….. 199
6.15.5 Resources/Reading ………………………………………………………………………………………………………………………. 205
6.15.6 References ………………………………………………………………………………………………………………………………… 205
6.16 Population Health .….………………………………………………………………………………………………………………… 207
6.16.1 Context …………………………………………………………………………………………………………………………………….. 207
6.16.3 Content Online ……………………………………………………………………………………………………………………………. 207
6.16.4 Content …………………………………………………………………………………………………………………………………….. 207
6.16.5 Source Document ………………………………………………………………………………………………………………………… 214
6.17 Psychiatry / Mental Health……………………………………………………………………………………………………………… 215
6.17.1 Context …………………………………………………………………………………………………………………………………….. 215
6.17.3 Content Online ……………………………………………………………………………………………………………………………. 215
6.17.4 Content …………………………………………………………………………………………………………………………………….. 215
6.17.5 Source Document ………………………………………………………………………………………………………………………… 225
6.18 Radiology………...….…………………………………………………………………………………………………………………… 227
6.18.1 Context …………………………………………………………………………………………………………………………………….. 227
6.18.3 Content Online ……………………………………………………………………………………………………………………………. 227
6.18.4 Content …………………………………………………………………………………………………………………………………….. 228
6.18.5 References ………………………………………………………………………………………………………………………………… 236
6.19 Rehabilitation Medicine………………………………………………………………………………………………………………… 238
6.19.1 Context …………………………………………………………………………………………………………………………………….. 238
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6.19.3 Content Online ……………………………………………………………………………………………………………………………. 238
6.19.4 Content …………………………………………………………………………………………………………………………………….. 239
6.19.5 Useful Texts ……………………………………………………………………………………………………………………………….. 248
6.19.6 Endorsement ……………………………………………………………………………………………………………………………… 249
6.20 Research and Evidence-based Medicine..…………………………………………………………………………………………… 250
6.20.1 Context …………………………………………………………………………………………………………………………………….. 250
6.20.2 Background ……………………………………………………………………………………………………………………………….. 250
6.20.4 Content Online ……………………………………………………………………………………………………………………………. 251
6.20.5 Content …………………………………………………………………………………………………………………………………….. 251
6.21 Strategic Skills in Rural and Remote General Practice…………………………………………………………………………… 255
6.21.1 Context …………………………………………………………………………………………………………………………………….. 255
6.21.2 Background ………………………………………………………………………………………………………………………………… 255
6.21.3 Aim ………………………………………………………………………………………………………………………………………….. 255
6.21.5 Content Online …………………………………………………………………………………………………………………………….. 256
6.21.6 Content …………………………………………………………………………………………………………………………………….. 256
6.21.7 Teaching & Assessment Methods ………………………………………………………………………………………………………. 259
6.21.8 Resources ………………………………………………………………………………………………………………………………… 261
6.22 Surgery…………...….…………………………………………………………………………………………………………………… 262
6.22.1 Context …………………………………………………………………………………………………………………………………….. 262
6.22.3 Content Online ……………………………………………………………………………………………………………………………. 262
6.22.4 Content …………………………………………………………………………………………………………………………………….. 262
REFERENCES 274
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1.0 INTRODUCTION
1.1 Defining Rural and Remote Medicine
In Australia the term “general practice” is used to describe the medical specialty that provides primary continuing
comprehensive whole-patient medical care to individuals, families and their communities. However, when general
practitioners care for patients in certain contexts - typically within rural and remote areas - there are a clear set of
additional skills, competencies and professional values that are required in order to provide safe and appropriate
care. The Australian College of Rural and Remote Medicine (ACRRM) refers to this unique scope and nature of
general practice as “Rural and Remote Medicine”.
Rural and Rural Medicine is typically delivered through private community based practice facilities and hospitals,
however, it can also occur on roadsides, in remote clinics, jails, Aboriginal medical services or via telephone or e-
health systems. It is one of the hallmarks of a rural and remote practitioner that they have highly developed clinical
judgment and extended skill sets which allow them to safely care for patients in a variety of ways that would not be
typical of general practitioners in more urban settings. This includes providing certain specialised areas of care such
as surgery or obstetrics, and admitting and caring for adults and children in hospital (secondary) care settings.
The clinical scope, practices and values that characterise Rural and Remote Medicine within the medical specialty of
general practice are outlined in the curricula and professional standards that are set and maintained by ACRRM.
General practitioners who achieve these standards are recognised through the award of Fellowship of ACRRM.
Fellows of ACRRM receive full vocational recognition and are able to practise in any location throughout Australia.
An ACRRM position paper is available at www.acrrm.org.au defining the specialty within the context of international
literature.
1.2 Target Group

The ACRRM Primary Curriculum applies to general practice registrars training towards Fellowship of the Australian
College of Rural and Remote Medicine (FACRRM). It is also a reference for practising GPs maintaining their
FACRRM qualification. It defines the standards for independent general practice anywhere in Australia, with
particular focus on rural and remote settings.
1.3 Background
The Australian College of Rural and Remote Medicine (ACRRM) was formed in 1997 as an acknowledgment of:
 the importance of rural and remote medicine as a broad but discreet form of general practice
 the need for well-designed vocational preparation and continuing medical education for rural doctors, and
 the need to address the shortage of rural and remote doctors in Australia, by providing them with a separate
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Third Edition ACRRM Primary Curriculum Revised 2009
and distinctive professional body.
The development of a dedicated rural and remote medicine vocational curriculum was a natural extension of
ACRRM’s core vocational training and preparation role. A comprehensive Prospectus (1), and a Position Paper (2),
both published in 1997 established the need for a curriculum and indicated the major directions for further
development. The first edition of the ACRRM Primary Curriculum was published in 1998. The second edition was
published in 2003, and the third edition in 2006. Minor revisions were made to the third edition in 2009.
Other research and resources that expand on the definition, scope and nature of Rural and Remote Medicine are
available on the ACRRM website at www.acrrm.org.au.
1.4 Rationale – Why is Rural and Medicine Important?
Health Status
Australians living in rural and remote areas have unique health concerns that relate directly to their living conditions,
social isolation, socioeconomic disadvantage and/or distance from health services. Death rates due to injury are 1.5
times the urban rate, death rates from road accidents are double, and the death rate among aged people who fall is
triple the urban rate (3). The hospital admission rate due to diabetes is also much higher, and increases rapidly with
remoteness(3, 4). Yet rural people have lower access to health care compared with their metropolitan counterparts
because of distance, time factors, costs, and availability of transport. This disadvantage increases with geographical
remoteness (5, 6).
Aboriginal and Torres Strait Islander peoples make up approximately 16 percent of the total ‘remote’ population of
Australia and 48 percent of the ‘very remote’ population (7). On some indicators, in particular diabetes and renal
disease, Indigenous Australians have the worst health status in the world (3, 8). While there is considerable
congruence between Australia and other countries in patterns of health disadvantage, morbidity, and health risk
behaviours in rural and remote communites and Indigeous people. Indigenous people of Australia fall well behind
other first world countries’ rates of improvement(9). Distance, isolation, lower incomes, poor educational opportunities,
meagre housing, minority status, and lack of services all exacerbate the experience of health inequality (10).
Services and Workforce

This situation is compounded by shortages of health facilities and health professionals and rural people’s perceptions
of health. Rural Australians overwhelmingly prefer that medical services be provided locally, rather than travel to
healthcare services in cities (10). There is evidence suggesting that many rural people will avoid required specialist
treatment rather than travel to a city for it (6, 11). They also prefer to receive medical care from a familiar practitioner
with whom they feel comfortable and who can provide continuity of care (12).
Workforce shortages are a consistent feature of rural medicine all over the world. This is compounded by medical
sub-specialisation, which has tripled in the past 20 years due to technological developments (13). In Australia, rural
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medical workforce shortages persist and. without further intervention, are expected to worsen, despite current
Government investment in recruitment and retention. Without further intervention the situation is expected to worsen
(14, 15). There is ample evidence that:
 rural and remote communities have inadequate access to medical services
 they have a need for more local doctors who are able to provide an extended range of clinical services, and
 that there are negative health consequences associated with these unmet needs.
As a consequence of these shortages, rural and remote doctors work much longer hours and on-call far more than
their urban counterparts. These factors impact upon both patient and doctor safety and the potential quality of care
provided.
Quality and Safety

General practitioners working in rural and remote settings require a broader and deeper range of knowledge and
skills than their urban counterparts in areas such as public health, infectious disease, environmental health, and
cultural awareness. By providing a vocational preparation program for rural and remote medicine, ACRRM enables
doctors to develop the necessary knowledge and skills through dedicated education, training and assessment
programs that reflect the realities of rural and remote practice. This has a flow on effect of consolidating and
improving targeted teaching in rural and remote medicine throughout undergraduate and postgraduate education
institutions, and fosters growth in research into safe clinical care and the managing risk in the rural context (16).
Appropriate professional recognition of rural and remote medicine will also attract more doctors to this important field,
and ultimately improve safety by increasing the number of skilled practitioners and the overall quality of medical
services provided to rural communities.
Scope of Rural and Remote Medicine

Rural and remote medicine is a broad, horizontal field of practice that intersects many medical specialties. General
practitioners in rural and remote communites are commonly called upon to provide a continuum of care from primary
presentation to resolution, and deal with issues associated with public health in small communities. Because rural
and remote practitioners are required to undertake many of the tasks that their urban counterparts would refer to
specialists, their practice is both advanced and extended. They may provide services in areas such as obstetrics,
surgery, anaesthetics, and emergency care, and may do so across primary, secondary and tertiary settings. Their
office-based consultations will often require more complex decision-making and the use of more diverse clinical and
procedural skills (16). There is considerable evidence that general practitioners working in rural and remote areas both
in Australia(17-19) and overseas(20-22) are providing an increased range of procedural, emergency and other advanced
care services.
In Australia, the complexity and scope of the practitioner’s tasks increase as the degree of geographical remoteness
increases. For instance, the more remote the location, the more likely it is that the doctor will be required to manage
myocardial infarctions to a higher level, administer cytotoxic drugs, perform forensic examinations, stabilise multiple
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trauma patients pending retrieval, and coordinate discharge planning(17). This observation is consistent with data
from Canada, which has similar demographic challenges (23, 24). This extended scope has important implications for
training and for setting and maintaining of professional standards.
Distance from tertiary services and local workforce restrictions create unique challenges for general practice that are
best addressed by distinctive, functional and contemporary models of interdisciplinary teamwork. Rural and remote
practitioners commonly work in a range of roles and settings, including hospitals, private practice, Aboriginal medical
services, and community health centres. Many are required to divide their time between multiple settings. Multi-
disciplinary and multi-skilled teamwork is a core feature of rural practice. It involves local healthcare teams, as well
as urban-based referred care providers who may provide outreach and tele-medicine support. Rural and remote
practitioners may also require higher levels of local management and collaboration to ensure post-operative and
other follow-up care (16). In remote locations, this usually also involves working as part of a cross-cultural team with
Indigenous Health Workers who also have diverse, advanced, and extended practice roles (25).
Conclusion
Access to advanced medical care is a basic equity issue for all Australians. Many rural people experience
considerable distress when required to travel to cities for treatment. In some instances, this can lead to patients
refusing city-based specialist care, regardless of need (11, 25). It is widely acknowledged that appropriate vocational
preparation of general practitioners is critical if they are to continue providing advanced procedural and other
important medical services in rural and remote Australia.
Rural and remote medicine is a unique mode of general practice which differs from urban practice in terms of the
context, content and process of care (26). Rural and remote general practice demands extended knowledge and skills
drawn from multiple medical specialties. This, advanced skill set is applied in a context which requires unique modes
of practice, cultural understanding and organisational skills. These differences, combined with the particular set of
professional values required, marks rural and remote medicine apart as a unique field of practice within the specilaity
of general practice.
For all these reasons, it is vitally important that general practice registrars preparing to work in rural and remote
settings have access to appropriate medical training and accreditation standards to ensure competent, safe, and
culturally appropriate health care services across the variety of rural and remote contexts. This Primary Curriculum is
an important step towards achieving this goal.
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2.0 CURRICULUM
2.1 Aim
The Australian College of Rural and Remote Medicine (ACRRM) Primary Curriculum aims to produce Fellows who
can function as safe, confident and independent general practitioners across a full and diverse range of healthcare
settings across Australia, with particular focus on rural and remote settings.
ACRRM’s Vocational Training Program has a number of goals for registrars. By completing the ACRRM Vocational
Training Program, including meeting all curriculum requirements, registrars will:
1. Acquire the skills, knowledge and behaviours to practise safe, independent and comprehensive medicine as
general practitioners with a focus on practising in rural and remote communities.
2. Attain Fellowship of ACRRM by successfully completing the training and assessment pathway requirements.
3. Commit to maintain competency after attaining Fellowship through participating in a structured professional
development program.
The Primary Curriculum also underpins and articulates with the set of ACRRM Advanced Specialised Training
Curricula which promote advanced studies in selected subject areas relevant to rural and remote general practice in
Australia.
2.2 Purpose
The ACRRM Primary Curriculum is designed to be a practical resource, which clearly outlines the teaching, learning
and assessment requirements for Fellowship of ACRRM. It provides a clear description of the content, locations,
learning formats, assessment tasks and processes necessary for accreditation to undertake independent general
practice across the full and diverse range of urban, rural and remote settings in Australia. It represents a fundamental
resource for rural registrars, supervisors and teachers, providing a framework from which to plan educational and
assessment activities. It has been designed to ensure transparency, consistency and academic rigour in these
educational processes. It provides clear information on what is expected of FACRRM registrars.
2.3 Curriculum Framework

The curriculum is structured around the following elements:
1. Principles – 11 principles that form the conceptual and practical foundation for the curriculum
2. Learning outcomes – 72 learning outcomes that define the assessable knowledge and skills which registrars
must demonstrate, organised within the seven domains of rural and remote medicine, and
3. Curriculum statements – 22 statements that describe the content which should be taught, organised under
the major medical disciplines or practice areas.
The curriculum model in Figure 1 shows the interrelationship between these elements.
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Figure 1. Curriculum Model
Learning outcomes
Domains 1 2 3 4 5 6 7
Curriculum Statements
Principles
2.4 Principles
The following 11 principles underpin this Primary Curriculum:
1. Grounding in professional standards – The curriculum is designed to meet the professional standards as
described by the medical profession. The standards include:
 Defining the essential knowledge, skills, attitudes and values required of all general practitioners
across the range of working contexts in Australia;
 Defining the core body of knowledge and skills that forms the foundation for advanced and special
interest studies
 Recognition of prior learning and experience, and
 Meeting the assessment and certification criteria of the Australian Medical Council.
2. Responsiveness to community needs – The curriculum content responds to the diverse needs of the
Australian population, including the National Health Needs and Priorities determined by the Australian
Government, and also the needs expressed by rural and remote people and communities.
3. Responsiveness to the rural and remote context – The curriculum focuses on the key features that define
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rural and remote medicine and set it apart from more urban models of general practice. This includes
features such as after-hours care, extended clinical skills, emergency medicine, Aboriginal and Torres Strait
Islander health, and independence in decision-making.
4. Outcomes focus – The curriculum defines 72 learning outcomes that registrars must achieve. These form
the basis for the assessment blueprint and link with the content listed in the 22 curriculum statements.
5. Focus on experiential learning – The predominant teaching and learning approach is through experience in
a variety of structured placements, with supervision from experienced mentors and educators.
6. Applicability to practice – The curriculum content is applicable to the realities of rural and remote general
practice through utilization of a variety of flexible and contemporary teaching, learning and assessment
approaches, where deep rather than surface learning is achieved.
7. Validity, reliability and educational soundness – The curriculum and assessment processes are progressive,
academically rigorous, educationally sound, clinically relevant, valid, reliable, and are designed to have a
positive educational impact.
8. Appropriateness and acceptability of delivery and assessment methods – Curriculum delivery and
assessment methods have been designed to be appropriate and acceptable to registrars in rural and
remote contexts. This is done through distance learning, flexible delivery methods and interactive
approaches.
9. Utilisation of information technology – Curriculum implementation is based on a robust and innovative

technology platform – Rural and Remote Medical Education Online (RRMEO) – which enables registrars
and their supervisors to plan, monitor, record and review the achievement of learning outcomes.
10. Articulation with advanced studies – The body of knowledge and skills described in the Primary Curriculum
has been designed to articulate with advanced and special interest vocational and tertiary studies.
11. Contribution to improving workforce capacity – The training and assessment program outlined will contribute
to building a skilled, confident, safe and competent Australian rural and remote general practitioner
workforce.
2.5 Learning outcomes

The learning outcomes describe the assessable knowledge, skills and attitudes that general practitioners require to
be able to work anywhere in Australia and particularly in rural and remote settings. The learning outcomes link
across the content found in the curriculum statements and provide a platform for the assessment program and its
blueprint. The ACRRM assessment is mapped to the learning outcomes.
The learning outcomes are organised under the seven domains of practice. These domains were developed through
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consultation with a diverse group of rural and remote practitioners, and by analysing the Australian and international
literature that describes this unique and evolving field of general practice. They do not represent the traditional
‘domains of learning’ often found in medical and other health professional curricula, but are ‘domains of practice’.
The domains are:
1. Core clinical knowledge and skills

2. Extended clinical practice
3. Emergency care
4. Population health
5. Aboriginal and Torres Strait Islander health
6. Professional, legal and ethical practice, and
7. Rural and remote context.
2.5.1 Domain 1 – Core Clinical Knowledge and Skills

Rural and remote people have a poorer health status, with higher morbidity and mortality patterns; yet often seek
medical advice late in the course of a disease due to stoicism, self-reliance and independence. These factors,
compounded by difficulties in geographical access and a lack of human and physical resources, require the health
professional to have a broader set of core clinical knowledge and skills than required in urban primary care settings.
This domain includes:
 Communication skills – the doctor patient relationship, listening, hearing, brief interventions, counselling
skills, tele-consulting
 Diagnostic skills – history taking, diagnosis, physical examination
 Investigative skills – pathology, radiology, ultrasound
 Clinical procedural skills – slit lamp, peri-anaesthetic, fractures, basic obstetrics, surgical procedures and
those requiring local anaesthesia
 Management skills – common acute and chronic conditions across the lifespan, envenomation, farm injuries
 Providing primary and secondary clinical care – rehabilitation, mental health, aged care, post operative
care, palliative care, and
 Best practice – universal precautions, standard treatment protocols and evidence-based practice
The assessable learning outcomes for this domain are:
101 Function as an effective and appropriate clinician in rural and remote general practice
102 Establish a doctor patient relationship and use a patient centered approach to care
103 Obtain a clinical history that reflects the different contextual issues including: the presenting problem,
epidemiology, culture, and geographical location
104 Perform an accurate physical examination that is relevant to clinical history, risks, and the age, gender and
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culture of the patient and the local disease epidemiology
105 Apply and describe diagnostic reasoning to arrive at one or more provisional diagnoses including common,
and uncommon yet important, conditions
106 Formulate and justify a plan of investigation and management related to the differential diagnosis
107 Consider uncommon but clinically important differential diagnoses
108 Apply core procedural skills in clinical practice
109 Use specialised clinical equipment as required for further assessment and to interpret results
110 Communicate findings of clinical assessment effectively and sensitively to patients, their families and/or
carers
111 Negotiate a management plan with patients, their families and/or carers
112 Revise the management plan and continually review and follow up as new information becomes available
113 Use evidence based standard treatment protocols and guidelines to inform decision making
114 Use the principles of universal precautions against infection in practice
115 Facilitate and coordinate access to services according to the individual patient needs
116 Develop and maintain clinical and service provider networks for effective patient care
117 Demonstrate capacity to apply quality assurance mechanisms and to appropriately use resources
118 Refer clients for specialist care and other services judiciously
2.5.2 Domain 2 – Extended Clinical Practice

Rural and remote medicine is a horizontal discipline that encompasses aspects of many other medical professions
and specialties (16). Just as the first domain represents the breadth of core clinical knowledge and skills, this second
domain emphasizes the depth required of general practitioners in rural and remote contexts and it runs more deeply
across the specialties. The depth required of these extended clinical skills also increases with geographical
remoteness.
 Extended clinical skills – diagnosis, investigations and management of more complex, chronic and
advanced conditions which would normally be referred to a specialist in an urban setting
 Extended management skills – forensic examination, retrieval management, and primary, secondary and
tertiary care of complex conditions in consultation with regional support networks, based on community
needs and geographic locations e.g. psychiatry – psychosis
 Extended procedural skills – administering: streptokinase, cytotoxic drugs, dialysis; and tertiary level
obstetrics, surgery, anaesthetics, ophthalmologic procedures
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 After hours care – within the home, community and hospital setting
 Tertiary care – inpatient care in a hospital, post operative care, on call, when and how to refer, and
 Teamwork skills – working within a multidisciplinary and cross cultural team, where other team members
also work in an advanced and extended role with often different values, priorities and control issues.
201 Diagnose and manage complex, advanced or uncommon medical conditions across a broad scope of
unreferred practice
201.1 Justify the diagnosis and differential diagnosis by reference to the aetiology, pathogenesis and
epidemiology of the condition
202 Perform extended office and hospital-based diagnostic and procedural skills
203 Provide secondary and tertiary based care as required
204 Provide direct and distant clinical supervision and support for other rural and remote health care workers
205 Work as part of a rural or remote multi-disciplinary team that reflects the extended skills of other health
professions in providing effective patient care
206 Provide team leadership, inter-agency liaison, and participate in risk management programs
206.1 Know their own limitations and when and how to refer
206.2 Safety and occupational health
207 Demonstrate the ability to undertake the relevant forensic responsibilities
2.5.3 Domain 3 – Emergency Care

Emergency care skills are essential for all health professionals to work safely in rural and remote practice, due
largely to the much higher death rates from injuries, road accidents and falls in the elderly(3, 4). Rural and remote
practitioners are frequently required to work with emergency personnel (police, fire brigade, ambulance and retrieval
teams) and volunteers in their assessment, triage and management of multiple patients simultaneously. It is also
more likely in rural locations that the doctor may be personally acquainted with their patients, and that retrieval will be
required from difficult geographic locations. This requires special resourcefulness and extended competence in a
range of emergency skills to stabilise, manage, retrieve and transfer critically ill patients. The general practitioner is
often also responsible for debriefing the personnel concerned, supporting families, and performing the role of
Government Medical Officer. All of these responsibilities increase with geographical remoteness.
 Retrieval medicine – management, stabilisation, transport, evacuation and retrieval of critically ill patients;
consulting with emergency medicine specialists
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 Emergency medical skills – triage, resuscitation, emergency life support – advanced paediatric, obstetrics,
adult; forensic skills – sexual assault examination
 Management of common rural and remote emergency conditions – farm injuries, burns, fractures, attempted
suicide, drowning, car accidents, forensic and psychiatric conditions
 Disaster management – management planning, working with retrieval teams and volunteers, and
 Post disaster management – debriefing, defusing, grief counselling, autopsy and other Government Medical
Officer responsibilities, self-care post disaster.
301 Undertake initial assessment and triage of patients with acute or life threatening conditions
302 Stabilise critically-ill patients and provide primary and secondary care
303 Provide definitive emergency resuscitation and management across the lifespan in keeping with clinical
need, own capabilities and available services
304 Perform required emergency procedures and courses
305 Arrange and/or perform emergency patient transport or evacuation when needed
306 Demonstrate resourcefulness in knowing how to access and use available resources
307 Communicate effectively at a distance with consulting or receiving clinical personnel
308 Participate in disaster planning and implementation of disaster plans, and post-incident analysis and
debriefing
309 Provide inter-professional team leadership in emergency care that includes quality assurance and risk
management assessment in the rural and remote setting
2.5.4 Domain 4 – Population Health

Rural and remote populations have a poorer heath status than urban Australians and it worsens with remoteness. In
their role as service providers, general practitioners have the potential to influence change at the individual, family
and community levels. Therefore, it is important that all rural and remote practitioners are able to work within a
population health model to improve the health of the local populations. This requires them to have a broader and
deeper understanding of the issues that cause an impact upon a community’s health, than their city counterparts.
 Understanding a population health model – the historial, sociopolitical, economic, geographic, cultural and
family influences on health across the lifespan; social determinants of health; the demography and health
status of their rural or remote community and particular population groups e.g. women, children, cultural
groups, aged; and community health profile
 Public health infrastructure and interventions – water supply, sanitation, food supply, disease control
initiatives, environmental health services, teamwork in providing and planning public health services,
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providing public health advice, reporting and statutory requirements
 Prevention and health promotion – immunization programs, advocacy, health education strategies, brief
interventions
 Epidemiological concepts – patterns and prevalence of disease across the population
 Early detection – screening, surveillance, follow up, referral, and
 Systems and organisation of chronic care – patient records, register and recall systems, care planning,
clinical audits, using data, working with teams.
401 Analyse the social, environmental, behavioural, economic and occupational determinants of health that
affect the community’s burden of disease and community access to health-related services
402 Demonstrate an ability to apply a population health approach suitable to community practice profile
403 Integrate evidence based prevention, early detection and other health maintenance activities into practice at
a systems level
403.1 Undertake, supervise and monitor early detection strategies
403.2 Use brief interventions in managing chronic disease
403.3 Competently use clinical information and recall systems, particularly in the organised management
and evaluation of chronic disease across the practice population
403.4 Provide health education and health promotion strategies in practice
403.5 Provide continuity and coordination of care for their own practice population
404 Comply with statutory population health reporting and notification requirements
405 Evaluate the quality of health care for practice populations
406 Access and collaborate with agencies responsible for key population health functions including, public
health services, employer groups and local government
407 Understand the role of a medical advocate in the design, implementation and evaluation of interventions
that address the determinants of that population’s health.
2.5.5 Domain 5 – Aboriginal and Torres Strait Islander Health

Aboriginal and Torres Strait Islander peoples experience the worst health status in the world on some indicators, in
particular those for diabetes and renal disease (3). To be able to have a positive impact upon this health status, rural
and remote practitioners must be able to work in a culturally safe manner. This requires an understanding of the
social, political, historical and cultural influences on the health of Aboriginal and Torres Strait Islander peoples.
 Cultural influences on health – the social, cultural, historical, economical, epidemiological and political
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framework that influences Indigenous health status
 Health status – Aboriginal and Torres Strait Islander health status, disease states, health assessment – e.g.
adult well persons health check
 Culturally safe practice – cross cultural communication skills; cultural awareness and sensitivity; working as
part of a cross cultural team
 Social and emotional wellbeing – of individuals and communities
 Primary health care and community control – different medical roles and ethical frameworks, using a
primary health care approach, cross cultural team work and working with Indigenous health workers, and
 Managing conditions in remote Indigenous populations – different frames of reference, compliance, respect,
ethics, family and community issues, and the importance of maintaining confidentiality.
501 Demonstrate an understanding of the links between the social, cultural, historical, economic and political
framework that influence the health status of Aboriginal and Torres Strait Islander peoples
502 Apply clinical practice knowledge of the differing profile of disease among Aboriginal and Torres Strait
Islander peoples
503 Demonstrate an understanding of the differing cultural beliefs, values and priorities of Aboriginal and Torres
Strait Islanders peoples regarding their health and health care provision
503.1 Reflect on own assumptions, cultural beliefs and emotional reactions in providing culturally safe
health care for Indigenous Australians
504 Communicate effectively and in a culturally safe manner with Aboriginal and Torres Strait Islander people
504.1 Identify key community contacts, mentors and support structures in the provision of effective health
care
505 Develop capacity building and skills transfer strategies when working with Indigenous health care workers
506 Describe the common patterns and prevalence of disease, and use best evidence in the management of
chronic diseases experienced by rural and remote Aboriginal and Torres Strait Islander peoples
507 Appreciate the role and effect of comprehensive Aboriginal community-controlled Primary Health Care
including self-determination, collaboration, partnership and ownership
507.1 Use a primary health care approach in rural and remote Indigenous health practice
507.2 Discuss the different power-based structures and decision making that need to be taken into
account when working in a community controlled organisation
508 Identify overt, covert and structural forms of discrimination in interactions with patients, health professionals
and systems; and advocate for their resolution
509 Work effectively and respectfully as part of a cross cultural team, and use local protocols for referral and
involvement of health workers
509.1 Describe the role of the Aboriginal and Torres Strait Islander Health Worker
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510 Apply principles of partnership, community ownership, consultation, capacity building, reciprocity and
respect to health care delivery, health surveillance and health research
511 List potential strategies to address social, economic and environmental determinants of disease among
Aboriginal and Torres Strait Islander Australians, and advocate for change
2.5.6 Domain 6 – Professional, Legal and Ethical Practice

Rural and remote practitioners often work in relative isolation from colleagues of the same discipline. Yet they have
greater public visibility as they also live in, and are influential members of, the communities they serve. This situation
requires them to practice within legal and ethical frameworks that consider the sociology of small communities,
different cultural values and norms, and professional boundary issues.
 Ethical practice in small communities – respecting difference; cultural and ethical considerations in planning
and decision-making; confidentiality, advocacy for patients and colleagues, professional boundaries, referral
patterns
 Professional role – professional development, self-appraisal, critical thinking, using and undertaking
research, applying research and evidence to their practice, best practice, using standard treatment
protocols in remote practice; duty of care; practice management, time management, lifelong learning,
quality improvement
 Legislative issues – Government Medical Officer role, notification of disease, death and births, autopsy and
consent, knowing one’s professional limitations and when to refer
 Information technology – using information technology and communication networks to inform practice,
and
 Occupational health and safety – universal precautions.
601 Manage, appraise and assess own performance in the provision of health and medical care for patients
602 Engage in continuous learning and professional development in rural and remote practice
603 Engage in education of other medical and health professionals
604 Provide accurate and ethical certification when required for sickness, employment, social benefits and other
purposes
605 Apply knowledge of practice billing, insurance and health financing systems in clinical practice
606 Maintain confidentiality in small communities
607 Maintain professional and social boundaries
608 Use and undertake relevant research to inform practice
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608.1 Demonstrate an ability to think critically and make informed decisions
609 Use communication technology to network and exchange information with distant colleagues and for
continuing educational purposes
610 Contribute to the management of human and financial resources within a health organisation/medical
practice
611 Identify and apply strategies for self-care, personal support mechanisms, debriefing, and caring for their
family in the rural and remote context
612 Recognise unprofessional behaviour and signs of the practitioner in difficulty among colleagues, and
respond according to ethical guidelines and statutory requirements
613 Be aware of duty of care issues arising from providing health care to self, family, colleagues, patients, and
the community
614 Apply professional, ethical, and legal guidelines to their practice
615 Implement and adhere to occupational health and safety guidelines in practice
2.5.7 Domain 7 – Rural and Remote Context

Context permeates every clinical and professional situation and it is integral to every aspect of rural and remote
medicine (25). While all general practice must be sensitive to context, a much greater sensitivity is required in rural
and remote locations, as the context changes everything about the usual experience for the practitioner, the patient,
their family and the community. Geographic and professional isolation impact on the depth and breadth of medical
knowledge and skills required across all situations. This domain integrates both horizontally and vertically throughout
the entire curriculum, as it further defines the unique nature of rural and remote medicine.
 Understanding rural and remote people and communities – social, economic, historical, cultural,
demographic and political issues facing rural and remote communities, accountability to the community, the
role of the general practitioner, and their practice profile within the community
 Survival skills – working in geographic, social and professional isolation, resourcefulness, independent solo
practice, lack of access to specialist and allied health services, the realities of rural and remote community
life, direct responsiveness to community needs
 Interprofessional teams – working with a variety of educational, emergency and community service
providers, and
 Self-care – finding the balance, identifying personal support mechanisms, debriefing, caring for their family
and self-care in remote cross-cultural context.
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701 Apply to their role of general practitioner knowledge of the social, cultural, historical, economic and political
issues facing rural and remote communities
702 Demonstrate resourcefulness, independence, and self reliance while working effectively in geographic,
social and professional isolation
702.1 Respond to community needs
703 Identify and reflect upon their own personal strengths, values, attitudes, priorities and vulnerabilities in being
able to maintain balance between personal, social and professional responsibilities and in managing
isolation
704 Respect local community norms and values in own life and work practices
705 Identify and acquire extended knowledge and skills as may be required in order to better meet the health
care needs of the practice population.
2.6 Curriculum Statements

The content that must be taught is organised into 22 curriculum statements according to the major medical
disciplines, or practice areas. A process of extensive consultation with rural and remote doctors throughout this
country was undertaken to achieve a consensus on the content of each of these curriculum statements. The content
covered in each of the curriculum statements is based on clinical presentations and problem solving where possible,
and takes into account the realities of rural and remote medicine and its comprehensive nature. The full curriculum
statements are presented in Section 6.0.
The disciplines covered by the 22 curriculum statements are:
1. Aboriginal and Torres Strait Islander Health

2. Adult Internal Medicine
3. Aged Care
4. Anaesthetics
5. Child and Adolescent Health
6. Psychiatry/Mental Health
7. Emergency Medicine
8. Information Technology/Information Management
9. Management
10. Musculoskeletal Medicine
11. Obstetrics/Women’s Health
12. Office based general practice
13. Ophthalmology
14. Oral Health
15. Palliative Medicine
16. Population Health
17. Dermatology
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18. Radiology
19. Rehabilitation Medicine
20. Research and Evidence Based Medicine
21. Strategic Skills in Rural and Remote General Practice
22. Surgery
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3.0 IMPLEMENTATION
3.1 ACRRM Training Standards

ACRRM aims to support doctors through its vocational preparation programs, to ensure they learn the knowledge
and skills they will need to work safely, competently, independently and confidently, as general practitioners
anywhere in Australia. Particular focus is placed on preparation for work in the diverse range of rural and remote
general practice settings.
ACRRM’s training standards define:

 The content and assessment of training
 The context of training, and
 The implementation of the training.
These standards include:

 The ACRRM Primary Curriculum
 The ACRRM Advanced Specialised Training Curricula
 The ACRRM Standards for Accreditation of Practices and Posts’ and
 The ACRRM Standards for Accreditation of Training Providers.
The ACRRM training standards ensure that registrars receive the highest quality training across a range of rural and
remote general practice settings. To facilitate delivery of training in keeping with these standards, the College has
developed a range of educational resources, and mechanisms for tracking, recording and certifying the achievement
of training goals and assessment requirements. These resources are available to registrars who seek to train
towards ACRRM Fellowship and to the training providers who are accredited to deliver this training.
3.2 ACRRM Training Pathways

ACRRM offers three different pathways by which registrars may train to meet the requirements for Fellowship of
ACRRM (FACRRM).
1. Vocational Preparation Pathway

The Vocational Preparation Pathway (VPP) is the predominant pathway for training towards FACRRM and is ideal
for new graduates. In this pathway, training is delivered by Regional Training Providers (RTPs) in the Australian
General Practice Training program (AGPT). This pathway is funded by the Australian Government and auspiced by
General Practice Education and Training Limited (GPET).
Registrars who wish to undertake training via this pathway must successfully enrol with both the AGPT and ACRRM.
Further information regarding AGPT enrolment is available at www.agpt.com.au.
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2. Remote Vocational Training Scheme
The Remote Vocational Training Scheme (RVTS) was established in 1999 as a joint training initiative of ACRRM and
the RACGP. It is now managed by the Remote Vocational Training Scheme Limited, and is funded by the Australian
Government. This pathway provides vocational training for isolated rural general practitioners who otherwise could
not undertake training except by leaving their communities. The RVTS delivers a structured training program to these
doctors almost entirely by distance education.
Registrars who wish to undertake their FACRRM training via this pathway must successfully enrol with both the
RVTS and ACRRM. Further information regarding RVTS enrolment is available at www.rvts.com.au.
3. Independent Pathway
Admission to the Independent Pathway (IP) is administered directly through ACRRM. The pathway is a full fee
paying pathway and is not subsidized or funded the Australian government. The IP is pathway suited to practitioners
who have broader and more extensive range of work experience than those who might elect to pursue training
through the VPP or RVTS. Registrars on the IP are required to have a leraning plan and must undertake a significant
amount of self directed learning. The pathway includes a structured education program. The training and assessment
requirements for the IP are the same as those for the VPP and RVTS pathways.
Registrars who wish to undertake training via this pathway must successfully enroll with ACRRM. Further information
regarding the IP is found at www.acrrm.org.au
3.3 Duration of Training

FACRRM registrars are required to complete a minimum of 48 months full-time or equivalent part-time training in
practices and posts accredited by ACRRM. This has been determined as the minimum time required to achieve
competence in the skills required for safe, independent general practice across a full and diverse range of healthcare
settings across Australia, including rural and remote settings.
Training is comprised of:
 12 months Core Clinical Training in an accredited metropolitan, regional or rural hospital

 24 months Primary Rural and Remote Training in accredited rural or remote hospitals, Aboriginal
Medical Services, general practices, small rural hospitals and/or community-based facilities, and
 12 months Advanced Specialised Training in accredited advanced posts. Approved training areas for
advanced posts include: Surgery, Obstetrics, Anaesthetics, Aboriginal and Torres Strait Islander Health,
Emergency Medicine, Mental Health, Adult Internal Medicine, Population Health, Paediatrics, and Remote
Medicine.
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3.4 Teaching and Learning Methods
ACRRM accredited training providers are encouraged to use a variety of different teaching and learning methods in
the delivery of the curriculum content. All teaching and learning methods should:
 be easily accessible and well designed
 be interactive and problem-based
 require critical thinking
 require application to the realities of rural and remote general practice, and
 challenge the learner to choose, judge and manipulate ideas and be resourceful.
Registrar learning experiences should include:
1. Supervised Structured Clinical Experience
 Opportunistic learning – learning and practising clinical skills in supervised environments.

 Formative assessment – registrars are provided with feedback and guidance about their progress from their
supervisor, external clinical educators and patients through two formative assessment tools: multi source
feedback (MSF) and the mini clinical evaluation exercise (MiniCEX).
2. Structured Learning Activities
 Learning plan development, documentation and review, including setting learning goals and documenting
these goals in the electronic learning planner available on RRMEO
 Workshops and courses – these may be undertaken in the registrar’s region, or in conjunction with a
conference or other event, and can be used to teach specific clinical skills or problem-based approaches
 ACRRM accredited skills based training courses – e.g. EMST, APLS, ALSO, ELS
 Small group teaching – through seminars and tutorials, problem-based learning to encourage collaborative
practice, problem solving, and knowledge and skill development
 Guided reflection on practice
 Weekly education sessions with supervisor
 Online tutorials, discussion forums, satellite broadcasts, interactive videoconferencing and teleconferencing
 Problem based learning – learning based around specific clinical problems, which are solved through
research, analysis and problem-solving, and presented back to a small group
 Videos, CD-ROMS and other audiovisual resources
 Demonstration of particular skills – especially advanced clinical skills practice
 Teleconferencing – to provide a peer group support to discuss the various issues and case studies,
 Small project work, case audits and research activities, and
 Application to practice – teaching and learning methods that are designed to apply evidence and theory to
the practical realities of contemporary rural and remote general practice. This could include issues-based
activities, critical thinking, decision-making exercises, leadership and management activities that include
planning, implementation and evaluation; cross cultural issues and organisational skills development.
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3. Self Directed Learning Activities
 Peer group discussion – registrars may work in a tutorless group, which may include structured activities,
projects, journal article review, problem solving and for collaborative research skills development
 Interactive computer based learning activities
 Undertaking research and projects, and
 Reflective journals – the use of reflective journals to record and monitor: attitudinal change, developing
capability, clinical reasoning skills, insight and skills development; and to assist registrars to reflect upon
their practice.
3.5 Teacher’s Roles

ACRRM vocational training is delivered by a network of accredited training providers. They provide registrars with
vocational preparation programs that comply with ACRRM Standards.
 Supervisor – each registrar must be linked to an ACRRM accredited supervisor who provides supervision,
clinical skills training, monitoring, guidance and feedback on professional and educational development.
This relationship forms the basis of an apprenticeship approach to learning.
 Clinical teachers – a variety of teachers, experts in particular content areas, and specialists may contribute
to various activities and workshops throughout the training time.
 Cultural teachers – community leaders and other experts involved in teaching the registrar about Aboriginal
and Torres Strait Islander culture and health
 Medical educator – The medical educator is a senior clinician, with experience in teaching and medical
education, who works for a training provider. The medical educator:
 provides advice to administrators, supervisors and registrars regarding the key components of the
pathway
 provides information to the registrar cohort regarding opportunities to train towards Fellowship of
ACRRM
 participates in the development of learning plans for ACRRM registrars
 monitors the registrar’s achievement of their broad goals through learning plans
 participates in, and advises on, placement allocation for ACRRM registrars, including the
Advanced Specialised Training year, and
 facilitates and encourages ACRRM accreditation of posts, including Advanced Specialised
Training posts.
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3.6 The RRMEO Education Management Platform
ACRRM provides registrars and training providers with an innovative education management platform – Rural and
Remote Education Online (RRMEO). RRMEO assists in planning, monitoring and managing the registrars’ learning
goals and achievements against the required learning outcomes. It also provides access to comprehensive, high
quality and relevant education resources for rural and remote general practice. RRMEO also offers a database of
face-to-face and online educational events (the Educational Inventory), which registrars can use to find training posts
and educational resources.
RRMEO is a suite of electronic tools that includes:
 An Educational Inventory database

 A Learning Planner
 A Learning Management System (LMS)
 An Administration Management System, and
 A localised Customer Support System.
RRMEO can be accessed at www.rrmeo.com.
3.7 Essential Resources

There are a number of essential resources that registrars will need to access throughout their training time. These
can be found electronically on the ACRRM website www.acrrm.org.au and on RRMEO www.rrmeo.com.
The core educational resources include:
 ACRRM Fellowship Vocational Training Handbook

 ACRRM Primary Curriculum
 Advanced Specialised Training Curricula
 ACRRM Standards for Accreditation of Teaching Posts and Teachers in Rural and Remote Medicine
 Access to the RRMEO Learning Planner and Educational Inventory
 Access to online training modules, including those found on RRMEO, and
 Access to a medical library for texts, journal articles and other core resources.
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4.0 ASSESSMENT
4.1 Programmatic Assessment Model

A programmatic assessment model is used for all pathways towards ACRRM Fellowship. A programmatic model
treats assessment as a ‘program’ across the entire duration of training, rather than just a specific instrument. It
therefore integrates assessment into all aspects of the curriculum (27). This approach enables multiple methods to be
used to assess learning outcomes and provides registrars with progressive feedback.
4.2 Assessment Principles

The assessment program is based on the following principles:
 Integration – assessment is integrated across the full duration of learning, taking place at regular intervals
throughout the entire training program
 Validity, reliability, fairness – the assessment program is based on best practice evidence, international
perspectives and proven valid, reliable, clinically relevant and fair methods that are adapted to the rural and
remote context
 Academic rigour and educational impact – the assessment program is academically rigorous and is
designed to have a positive educational impact that drives learning favourably
 Flexibility – the assessment program has multiple pathways, flexible timing and options for registrars, that
are practice-based or modular, depending upon their learning style and progress;
 Performance focus – where possible the assessment program is performance-based, which enables
smooth transition into ACRRM’s ongoing Professional Development Program
 Practice orientation and acceptability – the assessment tools, including the examination, are designed to
take place in the doctor’s own workplace, to ensure relevance and acceptability by the profession
 Outcomes focus – 72 learning outcomes form the basis for the assessment blueprint. The learning
outcomes are organised under the seven domains of rural and remote general practice , which are then
applied to the content listed in the 22 curriculum statements
 Feasibility – assessment is designed to be feasible with regards to cost, timeframe and the geographical
location of registrars
 Legal defensibility – assessment covers the core areas of competence required for general practice
vocational registration anywhere in Australia, plus the extended skills required of a general practioner
working in rural or remote settings
 Accessibility, flexibility – the assessment tools are designed specifically to meet the needs of rural and
remote contexts, including distance learning modes, flexible delivery, and interactive information technology
approaches, and
 Adherence to values and standards – The assessment components reflect the values of ACRRM in both
process, content and the nature of rural and remote general practice, and is based on professional
standards and criteria for assessment and certification.
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4.3 Assessment Framework
The structure of assessment is based on an adaptation of Miller’s Pyramid(28) below. This Pyramid represents a
behavioural approach to assessment with four progressive hierarchical phases of competence. The first being that
the registrar ‘knows’, the second that they ‘know how’, the third that they can ‘show how’, and finally, what the
registrar actually ‘does’ in the workplace(29).
Figure 2: Miller’s Pyramid (28)
Combining the Assessment Methods
VALIDITY
DOES Observation
Performance Practice based assessment
assessment Mini CEX
Multi-Source Feedback
SHOWS HOW Procedural skills logbook

Competence StAMPS – OSCE
assessment
KNOWS HOW StAMPS –Viva

Competence MCQ Exam
Course – EMST
KNO
NOWS MCQ Exam
Knowledge
Miller 1990
The representation of Miller’s Pyramid, in Figure 2 above, illustrates the well established principle that assessment of
knowledge, while important, is not sufficient to predict the application of this knowledge to practice(29, 30). Therefore
registrars are assessed using a range of formative and summative assessment methods, which cover the four stages
of Miller’s Pyramid. When combined together, these assessment methods form a rigorous, defensible formative and
summative assessment program with real educational impact.
4.3.1 Formative Assessment
The assessment program includes formative processes that provide opportunities for the registrar to receive
feedback and gauge their own performance throughout the course of training. These include:
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1. Regular supervisor and mentor feedback – timely and ongoing feedback on performance in practice
2. Practice Multiple Choice Question (MCQ) Examination
3. Multiple direct observations of performance – this includes some formative Mini Clinical Evaluation
Exercises (Mini CEX) exercises and other direct observations
4. Multi-source feedback (MSF), and
5. Learning Portfolio
4.3.2 Summative Assessment

There are five summative assessments that registrars must complete successfully in order to be awarded the
FACRRM. The summative assessment methods were chosen for their combined reliability, validity, feasibility,
acceptability and educational impact. They have been mapped against the assessment blueprint, to ensure that each
learning outcome is assessed using the most appropriate method.
The five summative assessment methods are:
1. Multiple Choice Question (MCQ) Examination

2. Structured Assessment using Multiple Patient Scenarios (StAMPS) Examination
3. Procedural Skills Log Book
4. Multi-Source Feedback (MSF), and
5. Mini CEX – Mini-clinical evaluation exercises to assess clinical and interpersonal skills. Mini CEX is used
summatively in the last 6 months of training.
4.4 Descriptions of Assessment Methods
4.4.1 MCQ Examination

The MCQ examination is an extremely reliable method for testing knowledge and clinical reasoning. It is used to test
the registrars’ applied clinical knowledge, recall and reasoning across the curriculum content areas. The examination
consists of 125 web-based multiple-choice questions undertaken in examination conditions over a three-hour period.
It can be undertaken anytime from the beginning of the second year of training, though it is strongly recommended
that registrars undertake it at a later stage in their training to ensure they have reasonable experience in rural and
remote practice.
4.4.2 StAMPS Examination

Structured Assessment using Multiple Patient Scenarios (StAMPS) is an innovative assessment modality in which a
combined OSCE / VIVA styles of examination is undertaken via videoconference. It is similar to an OSCE in that
clinical scenarios are presented within specific “stations”. It also has some similarities to the “admission OSCE” or
multiple mini-interview used by some medical schools to assist in admission into their medical program (31). In an
OSCE, the registrars rotate around a series of stations. The key difference with StAMPS is that the registrars remain
in one place (at a videoconference facility in, or close to, their own community) and the examiners rotate around all
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the registrars
The StAMPS examination was developed specifically to provide FACRRM registrars in rural and remote locations
with a reliable, affordable, flexible, acceptable and contextually relevant method for assessment of clinical reasoning
and problem solving skills. It measures each registrars’ ability to discuss, within a realistic period of time, the
implications arising from several common and important clinical scenarios seen in rural and remote contexts.
4.4.3 Procedural Skills Log Book

The procedural skills logbook enables registrars to record achievement of the essential psychomotor skills required
for competent independent general practice. These skills have been derived from the curriculum statements in the
ACRRM Primary Curriculum. The procedural skills logbook provides a means of assessing Miller’s Pyramid level 4.
As the clinical skills are competently achieved, the registrar records them in the logbook and the supervisor/ clinical
teacher provides ‘sign off’. This is an ongoing process throughout the entire course of the training program.
4.4.4 Portfolio
A portfolio is a useful tool for both formative and summative assessment, as it enables registrars to plan their
learning and also encourages reflection on practice. The RRMEO Electronic Learning Planner enables registrars to
record and manage their portfolio of work, including formative and summative assessments, completed throughout
their training.
Satisfactory completion of a learning portfolio is recorded in the registrar’s Electronic Learning Planner and includes:
 Completion of accredited posts
 Supervisors’ reviews
 Satisfactory completion of the required Emergency Medicine Courses
 Completed and validated procedural skills logbook
 Completion of online learning modules, including a minimum of four RRMEO online modules
 ACRRM recognition of prior learning statements (if relevant), and
 Formative assessment reports.
4.4.5 Multi Source Feedback

Multi Source Feedback (MSF) is a 360-degree practice-based assessment of the registrars’ interpersonal and
professional attributes (32, 33). It is not designed to assess clinical knowledge or skills.
The registrar undertakes a process of gaining structured written feedback from those people that they interact with
on a daily basis:
a. Health professionals – supervisors, practice managers, practice nurses, specialists, hospital staff,
Indigenous Health Workers, allied health professionals, others, and
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b. Community-Patients – families and carers who have consulted with the registrar.
MSF is used both formatively and summatively in FACRRM assessment. When used formatively, it enables the
registrar to receive feedback early in their training and can assist them in planning their learning and reflecting on
their choice of training program (33).
4.4.6 Mini CEX

The Mini Clinical Evaluation Exercise (Mini CEX) is a practice-based method for simultaneously observing and
assessing registrars and offering them feedback on their performance(34). A number of patient encounters are
observed by different assessors across a variety of clinical settings, throughout the course of the registrar’s training.
Registrars are observed conducting a patient history and examination and they are then asked about their diagnosis
and management. The assessor completes a rating form and seeks comments from the registrars.
The Mini CEX assesses history taking, physical examination, professionalism, clinical judgment, communication
skills, organisation skills, efficiency and overall clinical competence (34). It is used both formatively and summatively. It
provides an excellent quality improvement model which enables registrars to identify their strengths and weaknesses
through immediate feedback (34).
The Mini CEX provides a complete, valid, reliable and realistic clinical challenge to simultaneously examine clinical
skills in the registrar’s own clinical setting. In particular, it has been found to have high face validity (35).
4.5 Assessment Blueprint
DOMAIN 1 – CORE CLINICAL KNOWLEDGE & SKILLS
Learning Outcome MCQ StAMPS Logbook MSF MiniCEX Portfolio
101 Function as an effective and appropriate clinician

across primary, secondary, and tertiary care
settings.
  
102 Establish a doctor/patient relationship and use a
patient centred approach to care
  
103 Obtain a clinical history that reflects the different
contextual issues including: presenting problem,   
epidemiology culture, and geographical location
104 Perform an accurate physical examination that is
relevant to clinical history, risks, and the age,   
gender and culture of the patient and the local
disease epidemiology
105 Apply and describe diagnostic reasoning to arrive at
one or more provisional diagnoses including  
common, and uncommon yet important, conditions
106 Formulate and justify a plan of investigation and
management related to the differential diagnosis   
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107 Consider uncommon but clinically important
differential diagnosis  
108 Apply core procedural skills in clinical practice
 
109 Use specialised clinical equipment as required for
further assessment and to interpret results  
110 Communicate findings of clinical assessment
effectively and sensitively to patients, their families   
and/or carers
111 Negotiate a management plan with patients, their
families and/or carers   
112 Revise the management plan and continually
review and follow up as new information becomes 
available
113 Use evidence based standard treatment protocols
and guidelines to inform decision making 
114 Use the principles of universal precautions against
infection in practice   
115 Facilitate and coordinate access to services
according to the individual patient needs  
116 Develop and maintain clinical and service provider
networks for effective patient care 
117 Demonstrate capacity to apply quality assurance
mechanisms and to appropriately use resources   
118 Refer clients for specialist care and other services
judiciously  
DOMAIN 2 – EXTENDED CLINICAL PRACTICE
201 Diagnose and manage complex, advanced or

uncommon medical conditions across a broad
scope of unreferred practice
   
201.1 Justify the diagnosis and differential
diagnosis by reference to the aetiology,    
pathogenesis and epidemiology of the condition
202 Perform extended office and hospital-based
diagnostic and procedural skills 
203 Provide secondary and tertiary based care as
required   
204 Provide direct and distant clinical supervision and
support for other rural and remote health care   
workers
205 Work as part of a rural or remote multi-disciplinary
team that reflects the extended skills of other health    
professionals in providing effective patient care
206 Provide team leadership, inter-agency liaison and
participation in risk management programs 
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206.1 Know their own limitations and when and
how to refer 
206.2 Safety and occupational health

207 Demonstrate the ability to undertake the relevant
forensic responsibilities 
DOMAIN 3 – EMERGENCY CARE
301 Undertake initial assessment and triage of patients

with acute or life threatening conditions   
302 Stabilise critically ill patients and provide primary
and secondary care   
303 Provide definitive emergency resuscitation and
management across the lifespan in keeping with 
clinical need, own capabilities and available 
services
304 Perform required emergency procedures and
courses  
305 Arrange and/or perform emergency patient
transport or evacuation when needed   
306 Demonstrate resourcefulness in knowing how to
access and use available resources   
307 Communicate effectively at a distance with
consulting or receiving clinical personnel 
308 Participate in disaster planning and implementation
of disaster plans, and post-incident analysis and  
debriefing
309 Provide inter-professional team leadership in
emergency care that includes quality assurance 
and risk management in the rural and remote
setting
DOMAIN 4 – POPULATION HEALTH
401 Analyse the social, environmental, behavioural,

economic and occupational determinants of health
that affect the community’s burden of disease and
 
community access to health-related services
402 Demonstrate an ability to apply a population health
approach suitable to community practice profile   
403 Integrate evidence based prevention, early
detection and other health maintenance activities  
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into practice at a systems level
403.1 Undertake, supervise and monitor early
detection strategies 
403.2 Use brief interventions in managing chronic
disease 
403.3 Competently use clinical information and
recall systems, particularly in the organised
management and evaluation of chronic disease

across the practice population
403.4 Provide health education and health
promotion strategies in practice 
403.5 Provide continuity and coordination of care
for their own practice population 
404 Comply with statutory population health reporting
and notification requirements  
405 Evaluate the quality of health care for practice
populations   
406 Access and collaborate with agencies responsible
for key population health functions, including public  
health services, employer groups and local
government
407 Understand the role of a medical advocate in the
design, implementation and evaluation of  
interventions that address the determinants of that
population’s health
DOMAIN 5 – ABORIGINAL AND TORRES STRAIT ISLANDER HEALTH
501 Demonstrate an understanding of the links between

the social, cultural, historical, economic and political    
framework that influence the health status of
Aboriginal and Torres Strait Islander peoples
502 Apply to clinical practice knowledge of the differing
profile of disease among Aboriginal and Torres   
Strait Islanders people
503 Demonstrate an understanding of the differing
cultural beliefs, values and priorities of Aboriginal 
and Torres Strait Islander peoples regarding their   
health and health care provision
503.1 Reflect on own assumptions, cultural beliefs
and emotional reactions in providing culturally safe
health care for Indigenous Australians

504 Communicate effectively and in a culturally safe
manner with Aboriginal and Torres Strait Islander    
people
504.1 Identify key community contacts, mentors
and support structures in the provision of effective    
health care
505 Develop capacity building and skills transfer
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strategies when working with Indigenous health
care workers

506 Describe the common patterns and prevalence of
disease, and use best evidence in the management
of chronic diseases experienced by rural and   
remote Aboriginal and Torres Strait Islander
peoples
507 Appreciate the role and effect of comprehensive
Aboriginal community-controlled Primary Health
Care including self-determination, collaboration,    
partnership and ownership
507.1 Use a primary health care approach in rural
and remote indigenous health practice    
507.2 Discuss the different power based
structures and decision making that need to be 
taken into account when working in a community   
controlled organisation
508 Identify overt, covert and structural forms of
discrimination in interactions with patients, health 
professionals and systems; and advocate for their   
resolution
509 Work effectively and respectfully as part of a cross
cultural team, and use local protocols for referral 
and involvement of health workers
509.1 Describe the role of the Aboriginal and
Torres Strait Islander Health Worker 
510 Apply principles of partnership, community
ownership, consultation, capacity building,
reciprocity and respect to health care delivery, 
health surveillance and health research
511 List potential strategies to address social, economic
and environmental determinants of disease among 
Aboriginal peoples and Torres Strait Islanders, and  
advocate for change
DOMAIN 6 – PROFESSIONAL, ETHICAL AND LEGAL PRACATICE
601 Manage, appraise and assess own performance in

the provision of health and medical care for patients 
602 Engage in continuous learning and professional
development in rural and remote practice  
603 Engage in education of other medical and health
professionals 
604 Provide accurate and ethical certification when
required for sickness, employment, social benefits  
and other purposes
605 Apply knowledge of billing, insurance and health
financing systems in clinical practice 
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606 Maintain confidentiality in small communities
 
607 Maintain professional and social boundaries
 
608 Use and undertake relevant research to inform
practice  
608.1 Demonstrate an ability to think critically and
make informed decisions  
609 Use communication technology to network and
exchange information with distance colleagues, and 
for continuing education purposes
610 Contribute to the management of human and
financial resources within a health 
organisation/medical practice
611 Identify and apply strategies for self-care, personal
support mechanisms, debriefing, and caring for 
their family in the rural and remote context
612 Recognise unprofessional behaviour and signs of
the practitioner in difficulty among colleagues, and
respond according to ethical guidelines and 
statutory requirements
613 Be aware of duty of care issues arising from
providing health care to self, family, colleagues,   
patients, and the community
614 Apply professional, ethical, and legal guidelines to
their practice 
615 Implement and adhere to occupational health and
safety guidelines in practice   
DOMAIN 7 – RURAL AND REMOTE CONTEXT
701 Apply knowledge of the social, cultural, historical,

economic and political issues facing rural and   
remote communities to their role as a general
practitioner
702 Demonstrate resourcefulness, independence, and
self reliance while working effectively in geographic,  
social and professional isolation
702.1 Respond to community needs

703 Identify and reflect upon their own personal
strengths, values, attitudes, priorities and
vulnerabilities in being able to maintain balance
between personal, social and professional  
responsibilities and in managing isolation
704 Respect local community norms and values in own
life and work practices
 
505 Identify and acquire extended knowledge and skills
as may be required in order to better meet the   
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health care needs of the practice population
5.0 EVALUATION
This ACRRM Primary Curriculum is reviewed regularly every three to five years, to ensure it is up-to-date and
reflects contemporary general practice particularly in rural and remote settings, and that it is suitable to prepare
registrars to work anywhere in Australia. It is also evaluated on an ongoing basis through feedback received by
training providers, registrars, the profession, policy makers, and other key stakeholders.
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6.0 CURRICULUM STATEMENTS
This section consists of 22 curriculum statements that describe the specific knowledge and skills that registrars must
learn, organised under the major medical disciplines. These curriculum statements resulted from an extensive
consultation process with rural and remote doctors throughout Australia to achieve agreement on the content of each
of these curriculum statements. Each statement therefore takes into account the realities of rural and remote general
practice and its comprehensive nature.
Each curriculum statement defines the skills and knowledge that rural general practitioners require in that discipline.
These are defined broadly in terms of ‘General Instructional Objectives’ and then more specifically in terms of
‘Required Abilities and Skills’
The curriculum statements cover the following disciplines:

1. Aboriginal and Torres Strait Islander Health
2. Adult Internal Medicine
3. Aged Care
4. Anaesthetics
5. Child and Adolescent Health
6. Psychiatry/Mental Health
7. Emergency Medicine
8. Information Technology/Information Management
9. Management
10. Musculoskeletal Medicine
11. Obstetrics/Women’s Health
12. Office based general practice
13. Ophthalmology
14. Oral Health
15. Palliative Medicine
16. Population Health
17. Dermatology
18. Radiology
19. Rehabilitation Medicine
20. Research and Evidence Based Medicine
21. Strategic Skills in Rural and Remote General Practice
22. Surgery
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6.1 ABORIGINAL AND TORRES STRAIT ISLANDER HEALTH
6.1.1 Context
Prior learning and experience
Adult internal medicine, paediatrics, obstetrics
Concurrent learning and experience

A post in Aboriginal and Torres Strait Islander health, cross cultural training, and principles of rural and remote
general practice
Associated areas of study

Population health, sociology of rural and remote communities and adult internal medicine
6.1.2 Learning Objectives

The registrar will:
 understand the social, cultural, historical, economic and political framework that has influenced the current health
status of Aboriginal and Torres Strait Islander people
 understand the differing cultural beliefs of Aboriginal and Torres Strait Islanders people in regards to health and
health care provision
 understand culturally safe practice and the issues involved in cross-cultural interactions
 understand the common diseases and illnesses experienced by Aboriginal and Torres Strait Islander
Australians, and the management thereof
 understand the need to provide health care services that undertake a primary health care approach, and
contribute to the social and emotional wellbeing of the individual patient and the community as a whole
 understand the need for a multidisciplinary approach to the problems encountered in Indigenous health and to
develop an appreciation of the principles and practicalities of working in a manner which is empowering to
individuals and communities, and
 demonstrate a commitment to self-directed learning, continuing education and the conduct of quality assurance
activities in the provision of health services to Aboriginal and Torres Strait Islander Australians.
6.1.3 Content Outline
1. Recent Indigenous History 7. Health Status

2. Indigenous Culture 8. Primary Health Care
3. Population 9. Health Services for Aboriginal and Torres Strait
Islander Australians
4. Socio-economic Status 10. Health Assessment
5. Cross Cultural Communication 11. Referral
6. Culture Influences on Health Care Provision 12. Professional and Ethical Responsibilities
6.1.4 Content
Each of the 12 major topics in this curriculum statement is expressed through ‘General Instructional Objectives’ and
‘Required Abilities and Skills’. General Instructional Objectives are broad statements of the competencies to be
acquired, while ‘Required Abilities and Skills’ describe and define the specific abilities and skills involved and give
examples of behaviours that indicate the objective has been achieved.
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Third Edition ACRRM Primary Curriculum
Section Two
1. Recent Indigenous History
General Instructional Objectives Required Abilities and Skills

Explain and critically evaluate the impact of the Provide an overview of colonisation in Australia
colonisation of Australia and the introduction of including:
government regulation on Aboriginal and Torres Strait  the term ‘Terra Nullius’ and its significance
Islanders people  cultural revitalisation
 the background underlying colonisation in Australia
 the process of colonisation
 the resistance of Aboriginal and Torres Strait
Islander people to colonisation
Provide an overview of the history of Australian

government regulation in relation to Aboriginal and
Torres Strait Islander people including:
 segregation and protection policies, ‘smoothing the
dying pillow’ to ‘training for citizenship’
 assimilation, removal of children, the ‘stolen’
generation
 contemporary policies, community empowerment,
self determination, the growth of Indigenous
organisations
 land rights
 reconciliation
2. Indigenous Culture

Explain the concept of culture and its relationship to the Describe the contemporary socio-cultural characteristics
identity of Aboriginal and Torres Strait Islander people of Indigenous communities including:
 family organisation, extended family
 patterns of reciprocity and decision making
 social distance from non-Aboriginal and Torres Strait
Islander people
 folklore and identity
Demonstrate an understanding of the term ‘cultural Describe the importance of, and connection between,
safety’ and the application of culturally safe principles to cultural safety, recognition of cultural diversity among
health service delivery Aboriginal and Torres Strait Islander peoples and self
determination
Describe the issues pertinent to the practice of cultural

safety in health service delivery
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Section Two
3. Population

Create a living picture of the population and distribution Cite the population of Aboriginal and Torres Strait
characteristics of Aboriginal and Torres Strait Islander Islander people relative to the whole population, pre- and
people post-colonisation
Describe the major features of the distribution of

Aboriginal and Torres Strait Islander people:
 nationally
 in each state
 rural–urban distribution
 in his/her own region, town, community
Describe the demography of the Indigenous population

in terms of age and gender
Recognise the broad diversity of backgrounds and

lifeways of Aboriginal and Torres Strait Islander people
4. Socio-Economic Status

Demonstrate an understanding of the current social and Describe the current social and economic inequities
economic inequities experienced by Aboriginal and experienced by Aboriginal and Torres Strait Islander
Torres Strait Islander Australians and the link between Australians in relation to:
socio-economic factors and health status  employment status
 education status
 economic status
 housing status
 access and standard of environmental infrastructure
Describe barriers to accessing primary, secondary and

tertiary health services
Describe the social and economic determinants of health

and mechanisms by which these act
5. Cross Cultural Communication

Demonstrate an appreciation of the issues involved in Discuss the different communication styles of Aboriginal
communicating cross-culturally and Torres Strait Islander people and westerners,
recognising the diversity in both groups
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Section Two
Identify communication cues from Aboriginal and Torres

Strait Islander people and respond appropriately to them
particularly in relation to:
 gender issues in the patient/doctor relationship
 body space and touching
 questions about initiation marks
 limitations on questions about sexual organs, lore
and about other people
Describe the barriers to effective communication

between doctors, other staff and community members
including:
 socio-economic background
 cultural issues
 language
 health beliefs
 lore
 authority figures
 anticipation of approval from whites
 gender
Describe the concept of culture shock

Describe the concept of cultural safety
Identify strategies to maintain culturally safe practice
Define racism and describe the impact of racism on the
health and the delivery of health care to Aboriginal and
Torres Strait Islander Australians
Understand the concept of community held by Aboriginal
and Torres Strait Islander people and appropriate
protocols for consultation
Utilise culturally appropriate communication skills when:

 conducting a patient health assessment and
developing a management plan
 participating in team meetings, community meetings
or the meetings of other agencies
6. Cultural Influences on Health Care Provision

Demonstrate an understanding of world view of health Describe how the healing system of Aboriginal and
and well-being held by Aboriginal and Torres Strait Torres Strait Islander people works, including:
Islander people and how it differs from western views  the levels of healing practice
 the range of problems dealt with by an Aboriginal
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Section Two
Demonstrate an understanding and respect for the role healing specialist

of Aboriginal healing and healers in the Aboriginal  the system of usage by Aboriginal People
community
Promote practice which builds inter-sectoral collaboration
where appropriate between western and Aboriginal
medicine
7. Health Status

Outline the major features of the health status of Describe the known characteristics of the pre-colonial
Aboriginal and Torres Strait Islander Australians health status of Aboriginal and Torres Strait Islander
people
Compare and contrast the major current mortality and

morbidity patterns of Aboriginal and Torres Strait
Islander Australians to the Australian population as a
whole, particularly in relation to:
 fertility rate
 life expectancy
 maternal mortality
 infant mortality
 age-specific mortality and morbidity
Demonstrate an awareness of current major regional

differences in mortality and morbidity patterns
Explain the common age and sex specific causes of

morbidity, mortality, clinic presentation and hospital
admission for local Aboriginal and Torres Strait Islander
people, linking them with the associated socio-
economic, cultural and environmental factors
8. Primary Health Care

Demonstrate an understanding of the elements, Identify the shared characteristics of the primary health
concepts and activities of primary health care care model and the concept of health held by Aboriginal
and Torres Strait Islander people
Apply the principles of primary health care to his/her

clinical practice
Describe how preventive health care, including health
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Section Two
promotion and environmental health issues can be an

integral part of clinical practice relevant to the health of
Aboriginal and Torres Strait Islander Australians
9. Health Services for Aboriginal and Torres Strait Islander Australians

Outline the evolution, philosophy and characteristics of Describe the types, quality and effectiveness of western
health service delivery for Aboriginal and Torres Strait health service provided prior to the Aboriginal community
Islander Australians controlled health services movement
Explain the social and health conditions that underpin the

evolution of community controlled health services
Describe the philosophy of community controlled health

services
Explain ‘self determination’ as it is exercised in the

context, operation and activity of community controlled
health services
Outline the community controlled organisations in their

local area and the services they provide
Explain the relationship between government health

agencies and community controlled health services,
nationally, regionally and locally
Explain the concepts of social justice, equity of health

outcomes, and health rights in relation to Indigenous
health care provision
Appreciate the integral role of intersectoral and

interprofessional collaboration and the function of
Indigenous health workers in facilitating effective care of
the individual and the community
10. Health Assessment

Undertake a systematic and culturally sensitive Identify and evaluate the range of factors that has
approach to health assessment impacted on a patient’s health
Identify and appropriately consult with relevant parts of a

patient’s health decision making network with the aim of
developing a management plan
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Section Two
Identify situations where one on one consultations may

be inappropriate such as:
 gynaecological and obstetric examinations
 when lore issues are involved
 examinations for STDs
Be aware of spirituality and its impact on mental and

physical wellbeing
 consider spirituality problems as a potential
differential diagnosis in a range of physical and
psychological illnesses
 seek advice from Indigenous health workers when a
spirituality problem is suspected
Identify ‘high risk’ situations including:

 pre-existing physical illness
 compromised immunity
 social situations which place families at risk
 social situations which lead to inappropriate use of
health services
 alcoholism or other substance abuse
 history of domestic violence in the family
 history of mental illness
 implicated in death or injury of another aboriginal
person
 People travelling long distances or camped in other
communities
Acknowledge the need to evaluate available options and

their physical, social and psychological implications for
the patient, family, community, health team
Acknowledge the need to present options to the patient,

family and health team to enable their informed
participation in decision making
Acknowledge the need to negotiate and activate an

agreed plan of management
Co-operate with other team members and other health

care providers to provide optimal patient care
Establish effective follow-up and review mechanisms as

required including:
 review of procedures
 assessment of outcomes
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Section Two
 reassessment of health problems
Acknowledge the need for the capacity to offer and

implement a comprehensive health assessment and
treatment plan to patients opportunistically
11. Referral

Demonstrate awareness of the problems associated Acknowledge the necessity to liaise with Indigenous
with referral of Aboriginal and Torres Strait Islander health workers for advice on referrals as appropriate
people to western specialist centres such as:
 removal from home and family Describe the additional time and other resources that may
 travel arrangements need to be expended to ensure effective referral
 culture shock and language barrier
 financial problems Acknowledge the need to ensure travel arrangements
 problems with maintaining a reasonable have been optimised as part of a patients referral to
 informed consent process health care
12. Professional and Ethical Responsibilities

Demonstrate the ability to appraise own clinical Critically reflect on consultations and community based
performance activities to identify strengths and opportunities for
development
Demonstrate a commitment to the principles of Collaborate and work effectively with other team
coordination of care and the provision of continuity of members and other health care providers to provide
care optimal patient care including appropriate referrals,
transfers and evacuations
Appreciate the particular need and difficulty in Appreciate the importance of establishing protocols
maintaining confidentiality in rural/remote communities which outline confidentiality and integrity requirements
to staff
Demonstrate an ability to recognise one’s own Demonstrate an awareness of local and cultural issues
limitations and appropriately determine when to refer which impact on the decision to treat or refer
Demonstrate a commitment to ensuring that Aboriginal

and Torres Strait Islander Australians in rural/remote
communities receive health opportunities commensurate
with health care standards and opportunities available in
metropolitan areas
Outline strategies for self care and self reliance Develop a peer, professional and personal
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Section Two
support network
6.1.5 Source Document
The impetus for development of this curriculum statement came from recommendations made at the first National
Rural Health Conference in February 1991. These recommendations stressed the imperative nature of appropriate
education on and experience in Aboriginal and Torres Strait Islander Health for all health professionals wishing to
enter rural and remote practice. This momentum was picked up by the Rural Doctors Association of QLD (RDAQ)
and the Rural Rural Doctor Association of Australia (RDAA) who made representations to the RACGP, who at this
time had sole responsibility for vocational preparation of rural and remote general practitioners in Australia.
The RACGP subsequently established an Aboriginal and Torres Strait Islander Health Taskforce, chaired by Dr Neil
Beaton. Funds were sought and won from the Federal Government’s Rural Health Support Education and Training
Program for the development of a curriculum in Aboriginal and Torres Strait Islander Health for rural medicine. The
National Aboriginal Community Controlled Health Organisation (NACCHO) and the RACGP Faculty of Rural
Medicine oversaw the development of this curriculum and the project was completed in August 1994. The Steering
Committee comprised:
Dr Neil Beaton, Medical Advisor and Project Manager, QLD

Mr Les Collins, NACCHO Project Officer, QLD
Ms Naomi Mayers, NACCHO, Redfern, NSW
Mrs Mary Martin, NACCHO, YulliBurri-Ba Corporation for Health, QLD
Ms Nancy Long, MACCHO, Wuchopperan, QLD
Ms Christine Prior, NACCHO, Townsville, QLD
Dr Louis Peachey, Rural Trainee Association, Cunningham Centre, QLD
Ms Sally Johnson, CRANA, QLD
Dr Peter Holt, RDAA, QLD
Dr Tom Doolan, RDAA and (then) National Director Rural Education and Training, RACGP
The consultation process included all 21 members of NACCHO executive, the 12 members of the Taskforce on
Aboriginal Health, RACGP, RDAA, CRANA, registrars and resource persons identified by the Steering Committee. A
final position paper was endorsed by all the organisations involved before the curriculum was drafted. Responsibility
for writing the curriculum was given to Professor Ian Wronski and Ms Maggie Grant of James Cook University, QLD.
External evaluation consultants were Ms Anna Nichols, University of Queensland and Professor David Prideaux,
School of Medicine, Flinders University, SA.
ACRRM’s curriculum statement on Aboriginal and Torres Strait Islander Health draws extensively from the original
curriculum titled Core Rural Training Curriculum Content outlined in the Aboriginal and Torres Strait Islander Health
Curriculum Design Project – Final Position Paper. The ACRRM curriculum statement has been endorsed by
NACCHO.
6.1.6 Acknowledgements
ACRRM would like to thank NACCHO for making this project possible and the following individuals for their valuable
contribution to the development of this component of the ACRRM Primary Curriculum:
Working Party
Associate Professor John Wakerman
Ms Sue Lenthal
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Dr Neil Beaton
Dr Tom Doolan
Dr Sophie Couzos
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6.2 ADULT INTERNAL MEDICINE

6.2.1 Context

Medical school terms in adult internal medicine

Rural/remote general practice posts and rural/remote hospital posts

Paediatrics, emergency management, surgery, principles of rural and remote general practice, aged care
The registrar will:
 demonstrate a thorough grounding in the theory and practice of Adult Internal Medicine
 demonstrate expertise in history taking, physical examination, diagnosis, therapeutics and rehabilitation
 understand the pharmacology of drug delivery
 be able to work as part of a multidisciplinary team, including making appropriate referral to other health care
professionals
 demonstrate skills in identifying medical problems and developing appropriate strategies for their solution
 understand the importance of coordination of care and continuity of care, and
 demonstrate a commitment to self-directed learning, continuing education and the conduct of quality
assurance activities relevant to the field of Adult Internal Medicine.
1. Cardiology 5. Gastroenterology
1.1 Background Knowledge 5.1 Gastrointestinal Emergencies
1.2 Arrhythmia 5.2 Common Gastrointestinal Symptoms
1.3 Ischaemic Heart Disease 5.3 Upper Gastrointestinal Disease
1.4 Hypertension Heart Disease 5.4 Hepatobiliary Disease
1.5 Valvular Heart Disease 5.5 Pancreatic Diseases
1.6 Cardiac Failure 5.6 Small and Large Bowel Diseases
1.7 Peripheral Vascular Disease 5.7 Ano-Rectal Disease
2. Nephrology 6. Rheumatology
2.1 Glomerular Nephropathics 6.1 Rheumatological Emergencies
2.2 Urinary Tract infections 6.2 Common Rheumatological Problems
2.3 Acute Renal Failure 7. Endocrinology
2.4 Chronic Renal Failure 7.1 Background Knowledge
2.5 Vascular Disease of the Kidney 7.2 Diabetes Mellitus
2.6 Urinary Tract Calculi 7.3 Thyroid Disease
3. Thoracic and Sleep Medicine 7.4 Adrenal Cortical Disease
3.1 Background Knowledge 7.5 Pituitary Disease
3.2 Asthma 7.6 Sex Hormone Disease
3.3 Chronic Obstructive Airways Disease 7.7 Parathyroid Disease
3.4 Respiratory Infections 7.8 Other
3.5 Neoplasia 8. Neurology
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3.6 Pulmonary Embolism 8.1 Background Knowledge

3.7 Pleural Disease 8.2 Assessment of Patient Condition
3.8 Spontaneous Pneumothorax 8.3 Focal Neurological Signs
3.9 Hypersensitivity Pneumonitis 8.4 Cerebro Vascular Accident
3.10 Interstitial Lung Disease 8.5 Headache
3.11 Occupational/Environmental Lung Disease 8.6 Epilepsy
4. Infectious Diseases 8.7 Parkinson’s Disease
4.1 Zoonoses 8.8 Confusional States and Intellectual Impairment
4.2 Bacterial Infections 8.9 CNS Infection
4.3 Hepatitis 8.10 Space Occupying Lesions
4.4 Viral Infections 8.11 Other
4.5 Protozoal Infections 9. Professional and Ethical Responsibilities
4.6 Worms
4.7 Sexually Transmitted Disease
6.2.4 Content
Each of the 9 major topics of this curriculum statement is expressed through ‘General Instructional Objectives’
and ‘Required Abilities and Skills’. General Instructional Objectives are broad statements of the competencies to
be acquired, while ‘Required Abilities and Skills’ describe and define the specific abilities and skills involved and
give. examples of behaviours that indicate the objective has been achieved.
1. CARDIOLOGY
1.1 Background Knowledge

Demonstrate a working knowledge of basic cardiac Satisfactory completion of relevant subjects at medical
anatomy and physiology school
1.2 Arrhythmia

Demonstrate competence in the diagnosis and Know the aetiology and pathogenesis of Arrhythmia
management of patients with Arrhythmia including:
 Supraventricular Arrhythmias Describe and recognise symptoms and signs
 Ventricular Arrhythmias
Perform/arrange and interpret appropriate
investigations including:
 ECG
Reach a differential diagnosis
Perform emergency electrocardiograph and

cardioversion
Determine appropriate management plans:
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 immediate/urgent treatment
 implement local management or local
management with consultation
 arrange for referral and transfer if
 appropriate
 outline indications for referral to specialised care
Know the appropriate treatment options

 non-pharmacological
 Valsalva manoeuvre
 pharmacological
 Anti-arrhythmic and cardio-active agents
 IV use
 pharmacology
 dosage
 contraindications
 side effects
 assessment of response
 concordance
1.3 Ischaemic Heart Disease

Demonstrate competence in the prevention, diagnosis Know the aetiology and pathogenesis of ischaemic
and management of patients with ischaemic heart heart disease
disease including:
 myocardial infarction Conduct screening activities to identify high risk
 angina patients
Describe and recognise symptoms

 ECG

 arrange for referral and transfer if appropriate
Perform cardiac arrest procedures
Understand indications for and principles of coronary

surgery and post surgical treatment
Describe non-pharmacological strategies
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 weight reduction in the obese

 dietary sodium restriction
 regular exercise
 moderation of alcohol consumption
 modify dietary pattern
Know the appropriate pharmacological treatment:

 thrombolytic agents
 inotropic agents
 anti-anginal agents
 ACE inhibitors
 Diuretics
 Digoxin
 Vasodilators
 Beta Blockers
 Calcium Antagonists
 pharmacology
 dosage
 side effects
 concordance
Possess counselling skills
Discuss the treatment of complications
Possess skills in providing palliative care
1.4 Hypertensive Heart Disease

Demonstrate competence in the prevention, diagnosis Know the aetiology and pathogenesis of hypertensive
and management of patients with hypertensive heart heart disease
disease
Undertake prevention activities including screening for
hypertension and hyperlipidaemia
Describe and recognise symptoms and signs of:

 primary hypertension
 secondary hypertension
Demonstrate the ability to appropriately investigate all

grades of hypertension
 fundoscopy
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Know the range of treatment options:

 familiarity with clinical practice guidelines for
treatment, e.g. National Heart Foundation
 non-pharmacological strategies
 weight reduction in the obese
 dietary sodium restriction
 regular exercise
 moderation of alcohol consumption
 vegetarian eating pattern
Pharmacological treatment
 pharmacology of the anti-hypertensive agents
 dose
 side effects
 concordance
1.5 Valvular Heart Disease

Demonstrate competence in the diagnosis and Know the aetiology and pathogenesis of valvular heart
management of patients with valvular heart disease disease
including:
 aortic and mitral valve disease Describe and recognise symptoms and signs
 ventricular septal defect (VSD)
 atrial septal defect (ASD) Perform/arrange and interpret appropriate
 Bacterial endocarditis investigations including:
 ECG
 chest x-ray
 echocardiogram

Know the range of treatment options
Understand the management of patients with valve

replacements
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 prophylactic antibiotics
 anticoagulation
1.6 Cardiac Failure

Demonstrate competence in the diagnosis and Demonstrate knowledge of aetiology and pathogenesis
management of patients with cardiac failure including:
 acute left ventricular failure (LVF) Describe and recognise symptoms and signs
 congestive heart failure
 chronic LVF and cor pulmonale Undertake/interpret appropriate investigations
including:
 ECG

Know the range of treatment options
Perform cardiac arrest procedures
Provide/arrange rehabilitation services as appropriate

including:
 inpatient
 mobilisation program
 discharge planning
 secondary prevention education and
counselling
 explanation of condition, prognosis and
recovery process
 physical activity program
 lifestyle modification and behaviour change
regarding risk factors
 medications
 psychosocial issues
 plan for the management of symptoms
 referral to allied health professionals as required
e.g. physiotherapy, psychologist
 monitoring of risk factors
Provide palliative care as appropriate
1.7 Peripheral Vascular Disease
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Demonstrate competence in the diagnosis and Understand the aetiology and pathogenesis of
management of patients with peripheral vascular peripheral vascular disease
disease
Describe and recognise symptoms and signs

 ability to assess the significance of the severity of
intermittent claudication

Know the treatment options
2. NEPHROLOGY
1.2 Glomerular Nephropathics

Demonstrate competence in the diagnosis and Demonstrate knowledge of the immunopathogenesis of
management of patients with glomerular disease the major glomerulopathies

 urine analysis
 urine microscopy

Follow-up complications/problems following referral
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2.2 Urinary Tract Infections

Demonstrate the ability to diagnose and manage Understand the aetiology and pathogenesis of urinary
patients with acute and recurrent urinary tract tract infections
infections including:
 pyelonephritis Describe and recognise symptoms and signs
 cystitis
 prostatitis Perform/arrange and interpret appropriate
 urethritis investigations
 microbiology
 imaging
 ultrasound
 IVP

Know the treatment options:

 adequate fluid intake
 appropriate voiding practices
 pharmacological treatment as appropriate:
 pharmacology
 dosage
 side effects
2.3 Acute Renal Failure

Demonstrate competence in the diagnosis and initial Understand the aetiology and pathogenesis of acute
treatment of patients with acute renal failure renal failure
Initiate early management procedures undertaken

before transfer
Provide peritoneal dialysis in hospital as appropriate
Outline plan/protocol for referring and transferring

patients
2.4 Chronic Renal Failure
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Demonstrate competence in the diagnosis and Understand the aetiology and pathogenesis of chronic
management of patients with chronic renal failure renal failure
Understand the uraemia syndrome
Understand the management of chronic renal failure

including:
 CAPD and haemodialysis

Know the pharmacological treatment options

 use of drugs for patients with renal disease where
disease significantly alters the metabolism of the
drug
Understand the complications of chronic renal failure

and dialysis including:
 electrolyte imbalance
 dialysis disequilibriums
 pericarditis
 subdural haematoma
2.5 Vascular Disease of the Kidney

Demonstrate competence in the diagnosis and Understand the aetiology and pathogenesis of vascular
management of patients with vascular disease of the disease of the kidney
kidney including:
 polyarteritis nodosa Describe and recognise symptoms and signs
 hypersensitivity vasculitis
 haemolytic uraemic syndromes Perform/interpret appropriate investigations
 renal artery stenosis

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2.6 Urinary Tract Calculi

Demonstrate competence in the diagnosis and Understand the aetiology and pathogenesis of renal
management of patients with renal ureteric and ureteric and bladder calculi
bladder calculi

investigations
 IVP
 ultrasound, CT
 urine analysis

 implement local management or local management
with consultation

 analgesia
 fluid load
 calculi analysis
 definitive management for persistent calculi
 surgical
 lithotripsy
3. THORACIC AND SLEEP MEDICINE

Demonstrate a working knowledge of basic respiratory Satisfactory completion of relevant subjects in medical
and sleep physiology school
3.2 Asthma

Demonstrate competence in the diagnosis and Understand the aetiology and pathogenesis of asthma
management of patients with asthma and acute and acute respiratory failure including:
respiratory failure  incidence and prevalence
 trigger factors
Describe and recognise symptoms and signs:

 assessment of severity
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investigations:
 spirometry
 CxR
 arterial puncture for blood gas analysis

with consultation

 clinical practice guidelines e.g. National Asthma
Campaign
 smoking cessation
 occupational/environmental factors
 education of patients in self-care
 pharmacological agents
 allergen therapy
 beta-agonists
 theophylline
 inhaled steriods
 prednisolone
 pharmacology
 dosage
 side effects
 concordance
Use of nebulisers, spacers and turbuhalers
3.3 Chronic Obstructive Airways Disease

Demonstrate competence in the management of Describe and recognise symptoms and signs
patients with COPD and chronic respiratory failure  assessment of severity

investigations

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with consultation
Demonstrate competence in the diagnosis and
management of patients with obstructive and central Demonstrate skill in the use of oxygen concentrators
sleep apnoea
Outline indicators for long term domiciliary O2

 assessment of severity

investigations

with consultation
 indicators for referral for sleep study
Describe how to use CPAP
3.4 Respiratory Infections

management of patients with: respiratory infections
 acute and chronic bronchitis
 pneumonia (viral, atypical, bacterial) Describe and recognise symptoms and signs
 bronchiectasis
 tuberculosis Perform/arrange and interpret appropriate
 cystic fibrosis (pulmonary and extra pulmonary investigations including:
disease)  pertinent bacteriology, virology
 psittacosis  chest x-ray

with consultation
Prescribe antibiotics treatment as appropriate:

 pharmacology
 dosage
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 side effects
Outline infection control procedures
3.5 Neoplasia

Demonstrate competence in the diagnosis of patients Discuss the aetiology and pathogenesis
with bronchogenic and parenchymal neoplasms
Demonstrate an understanding of Para neoplastic
syndromes Perform/arrange and interpret appropriate
 bronchoscopy

with consultation
3.6 Pulmonary Embolism

management of patients with pulmonary embolism pulmonary embolism

investigations

with consultation
Outline indications for referral to specialised care
Know the pharmacological treatment options:

 heparins
 warfarin
 streptokinase
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 actilyse
 pharmacology
 dosage
 side effects
3.7 Pleural Disease

Demonstrate competence in the diagnosis and Understand the aetiology and pathogenesis (malignant
management of patients with pleural disease and benign disease processes) of pleural disease

investigations:
 needle thoracocentesis

with consultation
3.8 Spontaneous Pneumothorax

Demonstrate competence in the diagnosis and Demonstrate knowledge of the aetiology and
management of patients with Spontaneous pathogenesis
Pneumothorax

investigations

with consultation
Know the treatment options including:
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 insertion of an underwater drain

 emergency decompression of tension
pneumothorax
3.9 Hypersensitivity Pneumonitis

Demonstrate appropriate clinical suspicion of relevant Understand the aetiology and pathogenesis of
conditions including: Hypersensitivity Pneumonitis
 farmer’s lung
 bird fancier’s lung Outline symptoms and signs
Outline plan/protocol for referral to specialised care
3.10 Interstitial Lung Disease

conditions including: Interstitial Lung Disease
 sarcoidosis
 Wegener’s granulomatosis Outline symptoms and signs
 cryptogenic fibrosing alveolitis
3.11 Occupational/Environmental Lung Disease

conditions including: Occupational/Environmental Lung Disease
 occupational asthma
 asbestos related pleural and parenchymal disease Outline symptoms and signs
(benign and malignant)
 interstitial lung disease from exposure to organic Outline plan/protocol for referral to specialised care
and inorganic dusts
4. INFECTIOUS DISEASES
4.1 Zoonoses

management of patients with common Zoonoses such common Zoonoses
as:
 Q fever Describe and recognise symptoms and signs, time
 leptospirosis course and vectors
 brucellosis
 rabies Perform/arrange and interpret appropriate
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 anthrax investigations including:

 toxoplasmosis  diagnostic serology


 pharmacological treatment:
 vaccines
 antibiotics
 pharmacology
 dosage
 side effects
Understand potential complications
4.2 Bacterial Infections

management of patients with diseases such as: common bacterial infections
 meningococcal meningitis/septicaemia
 other meningitides Describe and recognise symptoms and signs
 typhoid
 pneumonia Perform/arrange and interpret appropriate
 tuberculosis investigations including:
 leprosy  blood cultures
 melioidosis  lumbar puncture

Demonstrate knowledge of treatment options
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4.3 Hepatitis

Demonstrate competence in the diagnosis and Understand the aetiology and pathogenesis of hepatitis
management of patients with the viral hepatitidies
Discuss prevention strategies:
 immunisation
 safe sex practices
 safe drug injecting practices

 diagnostic serology
 other relevant pathology
 liver biopsy


 pharmacological treatment:
 interferons for Hepatitis B and C
 pharmacology
 dosage
 side effects
Assessment of response
Outline relevant government policies and guidelines
Know of available education/information programs and

resources
Possess skills in providing counselling
Discuss psychosocial issues of affected population

groups
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4.4 Viral Infections

management of patients with common viral infections common viral infections
such as:
 influenza Describe and recognise symptoms and signs, time
 ross River Fever course and vectors
 measles
 mumps Perform/arrange and interpret appropriate
 varicella investigations including:
 epstein-Barr  diagnostic serology
 dengue
 rubella Reach a differential diagnosis
 herpes
Outline prevention strategies

 immunisation
4.5 Protozoal Infections

management of patients with common protozoal common protozoal diseases
diseases such as:
 malaria Describe and recognise symptoms and signs, time
 giardiasis course and vectors

 microscopy

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 prophylactic agents
4.6 Worms

management of patients with common worms such as: common worms
 round worms
 hook worms Describe and recognise symptoms and signs and time
 fluke worms course
 pin worms
investigations
Determine appropriate management plans
Demonstrate knowledge of treatment options
4.7 Sexually Transmitted Disease

management of patients with common STDs such as: common STDs
 gonorrhoea
 syphilis Describe and recognise symptoms and signs
 NGU/chlamydia
 herpes Conduct an examination for STDs including pelvic
 genital warts examination
 HIV/AIDS
 specimen collection for screening test/s
 conducting an examination for STDs including a
pelvic examination
 understand syphilis serology
 outline HIV antibody testing and protocols
Safely handle pathology specimens
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 know the treatment options

 principles of contact tracing and the management
of partners with STDs
Outline the legal requirements of general practitioners

in relation to STDs
Demonstrate skill in educating patients about

preventing STDs and negotiating safe sex
Understand the emotional and support needs of

patients with STDs
5. GASTROENTEROLOGY
5.1 Gastrointestinal Emergencies

management of patients with: gastrointestinal emergencies
 acute gastrointestinal haemorrhage
 liver failure Describe and recognise symptoms and signs
 hepatic encephalopathy
 acute colitis Determine appropriate management plans:
5.2 Common Gastrointestinal Symptoms

Demonstrate competence in the diagnosis and Elicit an accurate and detailed patient history
management of patients experiencing:
 weight loss Competently perform a physical examination
 abdominal pain
 dysphagia Perform/arrange and interpret appropriate
 iron deficiency anaemia investigations
 acute / chronic diarrhoea
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 nausea and vomiting Reach a differential diagnosis

5.3 Upper Gastrointestinal Disease

management of patients with: common upper gastrointestinal diseases
 gastro-oesophageal reflux disease
 peptic ulcer Describe and recognise symptoms and signs
 helicobacter pylori associated ulcers
 NSAID induced conditions Perform/arrange and interpret appropriate
 functional dyspepsia investigations including:
 gastric carcinoma  detection of Helicobacter pylori


 smoking cessation
 appropriate diet and eating patterns
 pharmacological treatment
 H2 Blockers
 proton pump inhibitors
 ‘triple’ therapy
 prokinetics
5.4 Hepatobiliary Disease

management of patients with : hepatobiliary disease
 alcoholic liver disease
 chronic liver disease (cirrhosis) and complications Describe and recognise symptoms and signs
 hepatitis
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 ascites Perform/arrange and interpret appropriate

 liver failure investigations including:
 haemochromatosis  pathology
 gall bladder disorders

5.5 Pancreatic Diseases

management of patients with: common pancreatic diseases
 acute pancreatitis and complications
 chronic pancreatitis and complications Describe and recognise symptoms and signs
 pseudocyst formulation and complications
 pathology

5.6 Small and Large Bowel Diseases

management of patients with: common small and large bowel diseases
 coeliac disease
 irritable Bowel Syndrome Describe and recognise symptoms and signs
 constipation
 appendicitis Perform/arrange and interpret appropriate
 infection investigations including:
 inflammatory bowel disease  plain and contrast abdominal X rays
 colonic adenoma/carcinoma  stool microscopy/culture/faecal fats
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 diverticulosis/diverticulitis  diagnostic ascitic tap

 lactose Intolerance  sigmoidoscopy/proctoscopy
 breath hydrogen test

5.7 Ano-Rectal Disease

management of patients with: common ano-rectal diseases
 haemorrhoids
 anal fissures Describe and recognise symptoms and signs
 anorectal abscess
 proctosigmoidoscopy

6. RHEUMATOLOGY
6.1 Rheumatological Emergencies

management of patients with: rheumatological emergencies
 acute mono/oligo arthritis
 acute polyarthritis Describe and recognise symptoms and signs
 systemic vasculitis
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6.2 Common Rheumatological Problems

Demonstrate competence in the diagnosis and Understand the epidemiology, socio-economic and
management of patients with: psychological impact of common rheumatological
 rheumatoid arthritis disorders
 osteoarthritis
 gout/pseudogout Techniques to evaluate and address disability
 back pain
 soft tissue rheumatism Understand the aetiology and pathogenesis of
 recognition of arboviral arthropathies common rheumatological problems
 temporal arteritis / PMR
 sero-negative arthropathies Describe and recognise symptoms and signs
 connective tissue disorders
 SLE Perform/arrange and interpret appropriate
 vasculitis investigations including:
 scleroderma  joint aspiration (knee, elbow, wrist, ankle)
 myositis  intra-articular steroid injection
 skin / muscle biopsy
 temporal artery biopsy
 synovial fluid


 use of physical methods e.g. splints
 physiotherapy
 weight reduction
 diet
 provide psychological support
 pharmacological agents including anti-
inflammatory, disease modifying and
immunosuppressive agents:
 analgesia
 pharmacology
 dosage
 adverse side effects
 safety monitoring procedures
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Collaborate with other health care professionals to

provide optimal patient care
7. ENDOCRINOLOGY
Demonstrate a working knowledge of the anatomy and Understand the basic mechanisms of hormone action
physiology of the endocrine system in health and disease
Understand the sites of hormone production
Understand the differing types of hormones
Understand the concept of receptor activity
Understand the concept of feedback control

mechanisms
7.2 Diabetes Mellitus

Demonstrate competence in the diagnosis and Understand the aetiology and pathogenesis of diabetes
management of patients with diabetes mellitus mellitus
Conduct screening activities to identify high risk

patients
Describe and recognise symptoms and signs of:

 undiagnosed diabetes
 diabetic ketoacidosis
 other forms of hyperglycaemia

investigations including :
 use of glucometers

Appropriately monitor diabetic control and screen for

complications

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 diet
 exercise
 weight reduction
 care for skin conditions and minor injuries to
lower limbs
 general education
 pharmacological agents
 insulin
 oral hypoglycaemics
 pharmacology
 dosage
 adverse side effects
 safety monitoring procedures
Outline principles of management of diabetes in

pregnancy including gestational diabetes
Demonstrate an understanding of the psychological

impact of newly diagnosed diabetes
Manage concurrent illness (especially gastroenteritis)

and be aware of implications for diabetics
Undertake a multidisciplinary approach to diabetes

care and outline the importance of patient participation
in management decisions and diabetes education
Develop a referral and advisory network for complex

problems
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7.3 Thyroid Disease

Demonstrate competence in the diagnosis and Understand the aetiology and pathogenesis of thyroid
management of patients with thyroid disease disease
Describe and recognise symptoms and signs for hypo

and hyperthyroidism
Perform/arrange & interpret appropriate investigations

Understand the implications of concurrent disease,

especially IHD
Understand the alternatives for long term therapy of the

hyperthyroid state

problems
7.4 Adrenal Cortical Disease

Demonstrate competence in the diagnosis and Describe and recognise the presenting symptoms and
management of patients with adrenal cortical disease signs of glucocorticoid and mineralocorticoid deficiency
and excess
Initiate and interpret appropriate investigations for

these conditions
Understand the implications of concurrent illness in

patients on glucocorticoid therapy
Understand the implications of acute withdrawal from

long term glucocorticoid therapy

problems
7.5 Pituitary Disease
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Demonstrate competence in the diagnosis and Identify the hormones produced by the hypothalamic-
management of patients with pituitary disease pituitary axis
Identify the symptoms, signs and syndromes caused

by specific disorders of pituitary dysfunction
Initiate and interpret appropriate investigations for

these conditions
Appropriately investigate disorders of pituitary

dysfunction

problems
7.6 Sex Hormone Disease

Demonstrate competence in the diagnosis and Recognise premature virilisation in children
management of patients with Sex Hormone Disease
Recognise pathologically delayed puberty
Recognise and appropriately investigate premature

gonadal failure
Advise patients on personalised risks/benefits of sex

hormone replacement therapy
Discuss common causes of sexual dysfunction and

advise appropriate therapy
 erectile dysfunction
 contraception and menstrual irregularities (see
Obstetrics/Women’s Health Module)

problems
7.7 Parathyroid Disease

Demonstrate competence in the diagnosis and Recognise the significance of abnormal serum calcium
management of patients with parathyroid disease and phosphate
Recognise the association with multiple calculi

formation, pseudo gout and parathyroid disease
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7.8 Other

Demonstrate competence in identifying rare endocrine Describe inappropriate ADH secretion syndrome
conditions
Describe symptoms and signs consistent with
phaeochromocytoma
Describe symptoms and signs consistent with carcinoid

syndrome
8. NEUROLOGY

Demonstrate a working knowledge of anatomy and Satisfactory completion of relevant subjects at medical
physiology of the nervous system school
8.2 Assessment of Patient Condition

Assess the status of a patient’s nervous system Take a full patient history relating to the nervous
system
Perform a detailed examination of the central and

peripheral nervous systems
Know each of the major modes of investigating the

nervous system including:
 lumbar puncture
 EEG
 EMG
 ultrasound
 CT scan
 MRI
Perform and interpret the results of a lumbar puncture
8.3 Focal Neurological Signs

Demonstrate competence in the diagnosis and Detect abnormal focal neurological signs/symptoms
management of abnormal focal neurological
signs/symptoms Understand the implications of abnormal focal
neurological signs
Appropriately investigate and/or refer patients with
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abnormal focal neurological signs/symptoms

problems
8.4 Cerebro Vascular Accident

Demonstrate competence in the diagnosis and Understand the aetiology and pathogenesis of cerebro-
management of patients presenting with transient vascular accidents
ischaemic attacks (TIAs) or cerebro-vascular accidents
(CVAs) Describe and recognise symptoms and signs of TIAs
and CVAs

for treatable causes of TIAs and CVAs

Know the treatment options for acute CVA or TIA
Instigate appropriate investigations for and

management of
Comprehensively evaluate patients who have suffered

a completed CVA
Organise appropriate rehabilitation for patients who

have suffered a CVA
8.5 Headache
Demonstrate competence in the diagnosis and Understand the differing causes of headache
management of patients with headaches
Differentiate on history the likely cause of the
headache
Appropriately investigate those headaches which do

not have an obvious and benign cause
Instigate appropriate treatment for the cause of each of

the types of headache
Manage the patient with a chronic pain syndrome

presenting as recurrent headaches
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problems
8.6 Epilepsy

Demonstrate competence in the diagnosis and Understand the aetiology and pathogenesis of epilepsy
management of patients with epilepsy
Describe and recognise symptoms and signs including:
 subtle presentations of epilepsy

of the patient with newly diagnosed epilepsy

 immediate/urgent treatment for a patient
presenting with an acute epileptic seizure
Know the pharmacological treatment options
Understand the psychosocial implications of newly

diagnosed epilepsy

problems
8.7 Parkinson’s Disease

management of patients with Parkinson’s disease Parkinson’s disease
Describe and recognise symptoms and signs including

early presenting features

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 non-pharmacological
 pharmacological
 antiparkinsonian medication
 side-effects
 surgery
Anticipate problems arising with the progression of

Parkinson’s disease
Provide increasing levels of support in the advanced

stages of the disease
Be aware of the role and stressors of carers of patients

with Parkinson’s disease

problems
8.8 Confusional States and Intellectual Impairment

management of patients with a confusional state common confusional states and intellectual impairment
Identify the possible causes of a confusional state (e.g.

dementia, deficiency diseases, intoxicants, infection,
hypoxia, metabolic causes, psychosis)

Know the treatment options for each of the causes of a

confusional state
Be aware of the principles of managing patients with

dementia
Understand the impact on carers of patients with

dementia
Organise support for the care of confused patients

within the community
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problems
Demonstrate competence in the diagnosis and Organise appropriate investigation and counselling for
management of patients with an intellectual patients and families affected by abnormal intellectual
impairment development
Recognise acquired brain injury
Organise appropriate management of patients with

acquired brain injury

problems
8.9 CNS Infection

Demonstrate competence in the diagnosis and Recognise the early signs of acute meningitis
management of patients with a CNS Infection
Instigate prompt and appropriate investigation and
treatment for suspected meningitis
Recognise the signs of chronic intracranial infection

and intra-cerebral abscess

problems
8.10 Space Occupying Lesions

Demonstrate competence in the diagnosis and Have a detailed knowledge of the causes of space
management of patients with space occupying lesions occupying lesions involving the CNS (infective,
(SOL) vascular, neoplastic)
Recognise symptoms and signs indicative of such a

lesion
Elicit a detailed and directed clinical history in order to

refine the suspected diagnosis of a space occupying
CNS lesion
Perform a detailed and directed clinical examination in

order to refine the suspected diagnosis of a space
occupying CNS lesion
Institute appropriate emergency treatment necessitated

by acute diagnosis of a CNS SOL
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Understand each of the modalities available to

investigate a CNS SOL
Choose the most appropriate method and timing for

investigating a suspected CNS SOL. (This should take
into account the special problems posed by distance
from imaging and specialty services)
Refer patients with a CNS SOL in a timely fashion for

definitive treatment
8.11 Other

Demonstrate appropriate clinical suspicion of relevant Recognise early presenting signs
conditions including:
 acoustic neuroma Instigate initial appropriate investigations or treatment
 Guillain Barre syndrome
 temporal arteritis Outline plan/protocol for referral to specialised care for
 benign intracranial hypertension diagnosis and treatment
 multiplesclerosis
 Bells palsy
 trigeminal neuralgia
9. PROFESSIONAL AND ETHICAL RESPONSIBILITIES

maintaining confidentiality in rural/remote communities which outline confidentiality and integrity requirements
to staff
Be aware of local issues which impact on the decision

to treat or refer, such as local transport and evacuation
processes
Demonstrate an ability to recognise one’s own Possess appropriate attitudes to balancing work, family
limitations and appropriately determine when to refer and leisure time, including a strong commitment to
lifelong learning
Outline strategies for self care and self reliance Develop a peer, professional and personal support
network
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ACRRM would like to thank the following individuals for their valuable contribution to the development of this
component of the ACRRM Primary Curriculum:
Working Party
Dr Tony McLellan
Dr Harry Johnston
Dr Kenneth Lim
Dr Jeremy Hayllar
Acknowledgment of further comment from:

Dr Tom Doolan
Dr Bill Lang
Professor Max Kamien
Dr Frank McLeod
Dr Stephen Sullivan
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6.3 AGED CARE
6.3 AGED CARE
6.3.1 Context

Medical school terms in adult internal medicine and general practice

Rural/remote general practice post, rural/remote hospital post

Adult internal medicine, rehabilitation medicine, population health, principles of rural and remote general practice
The registrar will:
 demonstrate the knowledge and skills necessary to provide appropriate and comprehensive care for older
patients in the rural/remote environment
 demonstrate expertise in history taking, physical examination, diagnosis, therapeutics and rehabilitation in the
older patient in the context of rural/remote practice
 demonstrate skills in identifying medical problems in older patients and developing appropriate strategies for
their solution
 understand the importance of coordination of care and continuity of care for the older patient, and
activities relevant to the field of aged care.

1. Background Knowledge 5. Enhanced Primary Care Activities
2. Management of Specific Conditions 6. Population Health
3. Functional Related Problems 7. Professional and Ethical Responsibilities
4. Care Provision
6.3.4 Content
Each of the 7 major topics of this curriculum statement is expressed through ‘General Instructional Objectives’ and
acquired, while ‘Required Abilities and Skills’ describe and define the specific abilities and skills involoved and give
1 Background Knowledge

Demonstrate an understanding of the ageing process Outline physiological, psychological and social age
related changes commonly experienced by the elderly
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6.3 AGED CARE
Describe attitudes of society towards ageing and the

aged
Demonstrate a knowledge of the special problems Outline the common issues surrounding the
relating to drug therapy in older patients pharmacodynamic and pharmacokinetic changes in
medication handling related to age and disease
Outline the issues associated with polypharmacy
Describe issues of compliance in the elderly and

strategies for improving concordance1
Outline the risks of iatrogenic drug induced diseases
Understand the importance of regular medication

reviews with advancing age and frailty
1 What does Concordance mean?
‘It is an agreement reached after negotiation between a patient and a health care professional that respects the
beliefs and wishes of the patient in determining whether, when and how medicines are to be taken. Although
reciprocal, this is an alliance in which the health care professional recognises the primacy of the patient’s decisions
about taking the recommended medications.
Consultations between patients and health care professionals are most often concerned with two contrasting sets of
health beliefs. Concordance recognises that the health beliefs of the patient, although different from those of doctor,
nurse or pharmacist are no less cogent and no less important in deciding the best approach to the treatment of the
individual’.
(‘What do we mean by concordance?’ Concordance Co-ordinating Group, Royal Pharmaceutical Society of Great
Britain. 1999. http://www.concordance.org accessed 15 June 1999).
Understand the impact of the ageing population on rural Outline the epidemiological characteristics of the ageing
and remote communities population in Australia
Describe the impact and implications of the ageing

population on the health care system in rural and remote
communities including:
 health service needs
 access to health services
 appropriateness of health services
 health service utilisation
Outline the legal responsibilities regarding Euthanasia,

Understand the legal responsibilities of the rural/remote Enduring Power of Attorney, Advanced Health Directive,
general practitioner in caring for the elderly patient fitness to drive etc relevant to the state
Possess the knowledge and skill required for decision
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6.3 AGED CARE
making and providing informed consent
Outline the legal standing of alternative decision makers
2 Management of Specific Conditions

Demonstrate competence in the management of specific Know the aetiology and pathogenesis of:
conditions with strong age associated risk  subdural haematoma
 cardiovascular disorders
 stroke and rehabilitation
 hypertension
 pulmonary disorders
 gastrointestinal disorders
 genitourinary and gynaecological disorders
 haematological disorders
 musculoskeletal disorders
 osteoporosis
 osteoarthritis
 metabolic and endocrine disorders
 thyroid
 diabetes
 infectious diseases
 neurological disorders
 Parkinson’s disease
 psychiatric disorders
 dementia
 depression
 skin disorders
 eye disorders
 ear, nose and throat disorders
Describe and recognise symptoms of above disorders in

the elderly patient
Be aware of the non specific and differing presentation of

specific diseases in older people
Undertake/arrange/interpret appropriate investigations
Be aware of the differing interpretation of laboratory

results in older people

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6.3 AGED CARE

with consultation
Understand and utilise appropriate treatment agents

 pharmacology
 dosage
 side effects
 concordance
Educate patients and/or carers about their condition/s

and negotiate treatment plan as appropriate
3 Functional Related Problems

Demonstrate expertise in recognition and management Outline the characteristics and management principles of
of the range of conditions that may affect the functional the following conditions in relation to functional status:
status of aged patients  nutritional problems
 syncope
 falls and gait disorders
 fractures
 acute confusional state
 behaviour disorders
 sleep disorders
 pain
 cancer
 pressure sores
 urinary incontinence
 sensory loss
 polypharmacy
4 Care Provision

Accurately assess the required levels of care for an older Perform a comprehensive functional assessment of the
patient older patient in terms of impairment, disability and
handicap that also includes social, psychological and
environmental dimensions
Deal effectively with patients presenting with several

interacting problems
Manage the patient with multiple disorders and rank

these in order of priority
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6.3 AGED CARE
Assess a patient’s suitability for care at home

considering family background, mental capability,
physical status, economic feasibility and home facilities
Administer functional and cognitive assessment scales

as appropriate
Outline principles and protocols for home visiting and

maintaining the elderly at home
Outline the role of aids (including hearing aids) and

appliances in the rehabilitation of older disabled patients
Be aware of and facilitate the appropriate use of

residential care facilities for the aged e.g. nursing homes,
Demonstrate knowledge of community resources hostels, respite care
Outline medical responsibilities for residential care

residents
Outline the community resources available to support

older people in the home
Understand the importance of continuity of care in

relation to caring for the older patient
Collaborate and work effectively with other team

members and other health care providers to provide
optimal patient care including appropriate referrals,
Undertake a multidisciplinary approach to the transfers and evacuations
coordination of care and the provision of continuity of
care Outline the medical role in a multidisciplinary team
Describe the role of allied health care workers in care of

the older patient
Be aware of services available in the community and the

means of accessing them
Facilitate utilisation of these services through a team

approach
Understand the importance of continuity of care in

relation to caring for the older patient
Be aware of the family dynamics of older patients in your

care
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6.3 AGED CARE
Demonstrate an understanding of the relationship Consult with other care providers to assist in determining
dynamics of families and the role of the doctor in the level of care required by a frail elderly patient
assisting families to make decisions regarding the care
of older patients Assist families to cope with the issues faced in caring for
a deteriorating elderly person
Assist in sustaining family relationships in times of

tension, stress and anxiety
5 Enhanced Primary Care Activities

Undertake activities which aim to improve the health Routinely undertake comprehensive health assessments
outcomes and quality of life for people with chronic for patients aged over 75 years
diseases
Participate in development, implementation and review
of multidisciplinary care plans for aged patients with
complex needs
Participate in case conferences for aged patients with

complex needs
Empower patients with the knowledge, skills, and

resources to self manage the symptoms of their chronic
conditions as appropriate
6 Population Health

Demonstrate an understanding of the importance of Be aware of current population health initiatives and the
health education and health promotion for the older role of rural/remote general practitioners in promoting
person healthy ageing:
 national targets and priority areas and population
health activities
 state and local health promotion and illness
prevention activities
Encourage older patients to undertake activities to

prevent illness and improve their general health relating
to:
 exercise
 diet
 social interaction
 accident prevention
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6.3 AGED CARE
7 Professional and Ethical Responsibilities

Demonstrate an understanding of the ethical issues Outline the importance in the face of illness and frailty of
involved in the care of older patients promoting older peoples’ dignity and sense of identity
Demonstrate expertise in the recognition and

management of elder abuse in its various forms
Critically reflect on consultations and community based

activities to identify strengths and opportunities for
development
Appraise own clinical performance Appreciate the importance of establishing protocols

which outline confidentiality and integrity requirements to
staff
Demonstrate an awareness of local issues which impact

Appreciate the particular need and difficulty in on the decision to treat or refer, such as local transport
maintaining confidentiality in rural/remote communities and evacuation processes
Understand and utilise the extended role of other health

care practitioners and services in the local area
Demonstrate the ability to recognise own limitations and
appropriately determine when to refer
Describe strategies for balancing the needs of a busy
practice with the ongoing needs of older patients
Demonstrate an awareness of the differing aged care
resources in rural/remote communities and ability to Develop a peer, professional and personal support
improvise when necessary network
Outline strategies for self care and self reliance
6.3.5 Acknowledgments
Working Party
Dr Kathryn Kirkpatrick (writer)
Dr Tom Doolan

Dr Brian Murphy
Dr Ken Pearson
Associate Professor Dennis Pashen
Dr Andrew Swanson
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6.4 ANAESTHETICS
6.4 ANAESTHETICS
6.4.1 Context

Medical school studies in anatomy, physiology and biochemistry

Postgraduate anaesthetic post

Emergency medicine, paediatrics, surgery, obstetrics
The registrar will:
 demonstrate the anaesthetic skills required to competently manage:

− acute airway problems including crash induction
− cardio-respiratory arrest and compromise
− transfer of patients, including ventilated patients
− pre-operative assessment and risk identification
− post-operative management of patients who have received analgesia, including epidural opiates and
spinal opiates
− post-operative anaesthetic complications
− regional nerve blocks, and
− other clinical cases where use of basic anaesthetic skills relating to airways, ventilation, and
cardiovascular function.

1. Background Knowledge 7. Anaesthetic Procedures
2. Trauma Management 8. Paediatric Considerations
3. Resuscitation and Emergency Care 9. Post-operative Anaesthetic Complications
4. Ventilators 10. Pain Management
5. Pre-operative Assessment of Patients 11. Professional and Ethical Responsibilities
6. Medical Conditions and Anaesthesia
6.4.4 Content
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6.4 ANAESTHETICS
1 Background Knowledge

Demonstrate knowledge of the anatomy of the upper Recognise and manage an obstructed airway
airway
Demonstrate knowledge of pharmacology of anaesthetic Provide for safe use of drugs in acute situations
agents commonly used
Identify and manage the physiological changes resultant
from drug use in anaesthesia
2 Trauma Management

Demonstrate competence in the management of trauma Understand the anaesthetic aspects of the early
management of severe trauma in rural/remote
communities
Have completed or be registered to undertake an EMST

course
Understand and apply EMST principles
Have completed or be registered to undertake an

Advanced Paediatric Life Support course
Undertake appropriate communications with senior

colleagues and referral agencies
Arrange appropriate transfer and evacuation

Demonstrate an understanding of the problems and
dangers involved in the transport of critically ill patients Understand the requirement for stabilisation and support
of critically ill patient at local hospital before transport or
retrieval is arranged
Know the principles underlying safe transport of critically

ill patients
Ability to communicate and cooperate with retrieval

teams
3 Resuscitation and Emergency Care
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6.4 ANAESTHETICS
Effectively manage patients of all ages suffering from a Identify causes, symptoms and signs of impending
cardiac or respiratory arrest cardiac or respiratory arrest
Note: See also Emergency Medicine Curriculum Have skills in airway management, expired air ventilation
Statement and external cardiac compression on patients and
models
Be familiar with drugs used in advanced life support
Know when and how to use a defibrillator
4 Ventilators

Understand the principles and practice of respiratory Describe principles of and indications for mechanical
support and ventilation, in particular in relation to use of ventilators
the oxylogue ventilator
Select parameters for ventilation i.e. respiratory rate and
Note: See also Emergency Medicine Curriculum tidal volume in acute patients
Statement
Describe appropriate monitoring for ventilated patients
Describe the complications of IPPV in hospital and in

transit, and their management
Outline the pharmacological management of ventilated

patients
Have skills in the use of ventilators in an emergency

situation
5 Pre-operative Assessment of Patients

Manage the pre-anaesthetic care of patients having Assess patient status by history taking, physical
elective surgery examination and relevant investigations
Be aware of anaesthetic risk factors and their pre-

operative management
6 Medical Conditions and Anaesthesia

Understand the effects of anaesthesia in various medical Elicit a detailed history and examination to determine any
conditions significant medical problems
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6.4 ANAESTHETICS
Arrange pre-operative investigations relevant to the

medical condition
Liaise with the anaesthetist when significant medical

conditions exist
Understand the various anaesthetic specific conditions Understand the management of anaesthetic specific
conditions such as scoline apnoea, malignant
hyperthermia, halothane hepatitis
7 Anaesthetic Procedures

Perform a range of anaesthetic procedures including: Know the pharmacology of local and topical anaesthetic
 local anaesthesia drugs
 topical anaesthesia
 regional nerve blocks Administer local and topical anaesthetics and be familiar
 post operative and labour (not epidural) analgesia with agents, dosing, side effect and techniques to
monitor pain
Administer regional nerve blocks and understand the

techniques, effects and complications and their
management
Perform crash induction in emergency and elective

Understand the indications and technique for crash (under supervision) intubations
induction of anaesthesia
Perform neuroleptanesthesia
Understand the principles of neuroleptanesthesia
8 Paediatric Considerations

Understand the pathophysiological differences in Provide for the pathophysiological differences in children
anaesthetised children e.g. O2 needs, temperature control, and fluid
replacement
Understand the use of local anaesthesia and
sedation in children Perform local anaesthesia in children using safe doses
and techniques which minimise the pain of the procedure
Perform safe sedation of children
9 Post Operative Anaesthetic Complications
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6.4 ANAESTHETICS
Manage the post anaesthetic care of patients having Diagnose post anaesthetic complications
surgery
Treat, refer and seek assistance as needed in providing
management of such complications
10 Pain Management

Understand the theories of pain and pain control Diagnose and classify pain appropriately
Provide pain interventions relevant to the type of pain

suffered
Refer patients appropriately for pain management
Recognise the different types of pain – acute, chronic, Provide treatment plans for the different pain types
post operative , and cancer related
Provide treatment for patients needing palliative care
including pain and other symptom management

Appraise own clinical performance Critically reflect on practice to identify strengths and
opportunities for development
Appreciate the importance of establishing protocols

Appreciate the particular need and difficulty in staff
maintaining confidentiality in rural/remote communities
Be aware of local issues which impact on the decision to
treat or refer, such as local transport and evacuation
Demonstrate an ability to recognise one’s own limitations processes
and appropriately determine when to refer
Develop a peer, professional and personal support
network
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6.4 ANAESTHETICS
Working Party
Dr Dan Manahan (writer)
Dr Mike Moynihan
Dr Tom Doolan

Dr Jon McKeon
Dr Chris O’Brien
Dr Kate Leslie
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6.5 CHILD AND ADOLESCENT HEALTH
6.5.1 Context

Completion of a prior attachment comprising a minimum of three months paediatrics will be recognised as
contributing to required experience for the course. The term must have provided opportunities for the registrar to gain
experience in hands-on diagnosis and treatment of general acute paediatric illness in a general paediatrics or A/E
setting, as recommended by the JCC Paediatrics. Many registrars will have had this opportunity in PGY2.

This curriculum statement has been designed for general practitioners intending to include rural Hospital work in their
modus operandi. Doctors intending to work in towns without hospitals will not need certain aspects of the described
work. Complete mastery of the entire content should take second place to the learning of subroutines enabling the
general practitioner to deal with situations competently as they arise, in consultation with Paediatricians if necessary,
and to build further competence as postgraduate experience is gained.

 Aboriginal and Torres Strait Islander Health
 Anaesthetics
 Dermatology
 Emergency Medicine
 ENT and Ophthalmology
 General Medicine
 Obstetrics, Neonatal Medicine and Women's Health
 Psychiatry
 Public Health
 Radiology
 Surgery
All these are interface areas and paediatric and adolescent components should be kept in mind to economise
teaching time. There could be combined adult and paediatric modules in ENT, Ophthalmology, Dermatology,
Aboriginal and Torres Strait Islander Health, Medicine, Surgery, and so forth. Proposed elements of obstetric training
in particular are important to Paediatrics. The pre-pregnancy and prenatal periods are cardinal to preventive
strategies. Good obstetric care partly determines paediatric outcomes. The postnatal period is highly important, and
experience in neonatal paediatrics might be gained while practicing both obstetrics and paediatrics, especially in the
rural or remote hospital setting. A genetics module may be advisable.
The registrar will:
 demonstrate the necessary skills to competently practise paediatric care in the office and community setting.
This care will incorporate consideration of the social environmental influences that impact on the presenting
problem (including family, carers, school and the physical environment)
 demonstrate the necessary skills to recognise minor and seriously acute and life-threatening conditions and to
be able to manage them selectively on an ambulant basis or in hospital
 demonstrate the broader skills necessary to assist the delivery of paediatric care in the hospital setting
 demonstrate competence in immediate neonatal care, resuscitation and the transfer and evacuation of neonates
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where appropriate, and be familiar with the normal care, conditions, and complications of the neonatal period
 demonstrate a working knowledge of problems common during the infant, toddler, school-age and adolescent
years, that warrant management in the general practice setting, by referral to specialist paediatricians, or in
conjunction with workers in childcare networks, and
 demonstrate the necessary skills to competently manage the special social, physical and mental problems and
habits of adolescents up to their age of maturity.

1. Paediatric Care in the Office and Community Setting 5.2 Developmental Issues
2. Acute Illness: Clinical and Management Skills 5.3 Common Problems
3. Neonatal Care 5.4 Psychosocial Issues
4. Infant, Toddler and School-Age Years 5.5 Communication/Assistance Strategies
5. Adolescence 6. Professional and Ethical Responsibilities
5.1 Relationships
6.5.4 Content
1 Paediatric Care in the Office and Community Setting

Recognise and appropriately manage common and Elicit an appropriate history, remembering the particular
important conditions of children and adolescents, needs and anxieties of parents with sick children, whilst
particularly those physical, psychological or social recognising their expertise as the close observer of the
conditions which could cause mortality or major morbidity child and the illness
if poorly managed.
Understand the range of normality in infants, children
and adolescents and feel confident in monitoring growth
and development
Engage with and examine children, remembering the

child's alertness, interest and responsiveness are critical
to accurate assessment
Negotiate an effective management plan that sets

realistic expectations between the parent, patient and
doctor
Accurately establish parental levels of understanding of

the condition including the indicators and mechanisms
for follow up
Utilise the therapeutic relationship to promote parental
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self-confidence and skills both directly and indirectly
Appreciate the context of general practice, and adjust the

Understand the spheres of influence that impact on child consultation style and management plan to respond to
and adolescent health, and the techniques necessary to influencing factors such as:
operate within these spheres concurrently during  beliefs and expectations of the wider family which
management of the problems being addressed shape the presentation of the problem
 the effect on treatment compliance of parental
attitudes to illness, medication, fever and alternative
remedies
 pressures of work, and the necessity to maintain
employment by both parents (as they affect the
capacity to care for sick children)
 the quality of family and community support, ie the
immediate environment in which care occurs (the
same clinical situation may require home or hospital
management)
 linguistic, ethnic and cultural barriers (which may
exclude a parent from part of the consultation)
 anxiety, sleep deprivation and level of understanding
affecting potential expectations of the consultation
both in the family and the practitioner
Understand the effects of family dynamics on child

presentations (treating the family rather than the child
may produce the best outcome for the child)
Understand the value of appropriate opportunistic mental

and physical health promotion and surveillance at every
Have a clear appreciation of the importance of physical interview and at all stages of childhood and adolescence
and mental health promotion and preventative strategies
that can be applied both formally and opportunistically Outline the advantages of the parent-held record as a
during the application of curative medicine. means of facilitating health promotion, developmental
surveillance and communication between health
professionals
Safely use relevant and appropriate pharmaceutical

agents and understand the precautions relevant to
pregnancy, lactation, infancy and adolescence
Be familiar with prevalent alternative therapies and be

able to explain in a sympathetic fashion their relevance
to situations at hand
Generate written and printed information/instructions to

support parental care which include clear statements
about indications for immediate review
Promote staff attitudes and a physical environment in
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which children and adolescents feel both welcome and at

Be familiar with practice organisation skills which ensure ease
appropriate access and quality of care for children,
adolescents and their families Create a safe physical environment in the practice for
children
Understand current Medicare or other governmental

requirements, appropriate billing procedures, and
provision of access to Medicare billing for adolescents
lacking a card
Undertake/interpret the following:

 height, weight, head circumference evaluation
 use of standard growth charts
Demonstrate skills in performing appropriate  standard developmental scales
investigations  standard immunisation procedures
 use of peak flow meters, aerosols, turbuhalers,
spacers, nebulisers
 spirometry
 venepuncture
Undertake a child psychology interview
Undertake a child/adolescent STI examination, avoiding

pelvic examination
Demonstrate competence in the performance of relevant
office procedures and protocols Undertake a forensic examination
Undertake ambulant management

 dehydration
 fever
 viral illnesses
 early, non-specific or ambivalent conditions
Understand the potential untoward psychological effects

of hospitalisation on children
Perform premedication for minor surgery
Perform skin anaesthesia
Perform skin lesion biopsy/removal
Repair lacerations
Teach dental flossing techniques
Be familiar with:
 the current immunisation schedules
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 prevalence of vaccine-preventable diseases

 the concept of opportunistic vaccination
 barriers to achievement of optimal rates of
Be conversant with current tools and strategies for immunisation
compliance with the National Immunisation Campaign as  current recommendations
it develops, and other immunisation requirements  true and false contraindications
including those required for travel  vaccine storage, and maintenance of the cold chain
Effectively communicate with other health care workers,

particularly rural hospital and non-hospital nursing staff
Understand the importance of informal networking, trust

and workload sharing with other medics and medical co-
workers in rural areas
Understand the operation and establishment of inter-
sectoral healthcare networks for families, children and Establish and work effectively with local networks of
adolescents, and the rural/remote doctor’s role as a relevant professionals and community groups including,
reference and coordination point for use of these regional paediatricians, and child and youth services,
networks local schools, social, cultural and recreational groups (be
aware that such networks are built up only slowly and
with goodwill and persistence)
Generate effective referrals which take into account the

economic and social circumstances of the rural family
and involve the family in a cooperative way
2 Acute Illness: Clinical and Management Skills

Demonstrate competence in the recognition and Understand the use and limitations of clinical indicators
management of serious illness in infants and young of serious illness in children with special reference to the
children evolution of serious illness over time
Understand the use and limitations of laboratory

indicators of serious illness in hospital and GP settings
Demonstrate competence in the assessment and Understand the principles and practice of emergency
management of the child with severe or life-threatening and acute paediatric life support.
illness or injury, if necessary in consultation with referral
centres, together with the necessary protocols for Competently perform the following accident and
stabilisation and transfer, or ongoing local hospital emergency skills:
management  basic life support
 early management severe trauma
Demonstrate competence in the co-management of  primary survey
acute conditions requiring retrieval or transport to referral  secondary survey
centres and the establishment of early telephone  neck stabilisation
communication  airway management, intubation
 hypovolaemia correction
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 hypoxia correction
Demonstrate competence in the hospital and after-  thoracocentesis
hospital care of conditions necessitating hospital  chest drain
admission  paediatric infusion
 intra-osseous infusion
 paediatric radiology
 catheterisation
 suprapubic aspiration
 removal of foreign bodies with and without GA
 simple fractures management with and without GA
 simple dislocations: joint and epiphyseal
 neonatal resuscitation: intubation and umbilical
catheterisation
 burns management: simple, moderate, severe
Demonstrate competence in the management of:

 head injury
 hypovolaemia
 acidosis
 hypoxia
 blood transfusion
Be appropriately involved in:

 ongoing education of hospital staff
Have a capacity as visiting or employed Medical Officer  management of in-patients directly and through
to become involved in aspects of hospital operation hospital staff
relevant to paediatric patient care  construction of a hospital environment sympathetic
to children
 infection control
 child-specific aspects of theatre operation and
where relevant the administration of paediatric
anaesthesia
 x-ray
 Board of Management
3 Neonatal Care

Demonstrate competence in the assessment and care of Manage abnormal perinatal care, emergencies, and with
the newborn neonatal resuscitation, including intubation and umbilical
catheterisation, and the necessary work up, in
consultation with referral centres, for evacuation when
indicated
Be competent in the resuscitation of the severely

compromised newborn baby
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Manage the normal and abnormal postnatal period both

in the context of hospital care and early discharge
Be familiar with the following neonatal conditions:

 respiratory distress
 asphyxia
 cyanosis
 hypoglycaemia
 hypothermia
 vomiting
 failure to pass meconium
 physiological jaundice
 non-physiological jaundice
 intraterm and neonatal infection
 seizures
 maternal syphilis, Hep B, Hep C, HIV
Understand and have competence in the normal care Manage both mother and baby in tandem, being
and promotion of health of the baby and mother, with sensitive to the effect that problems in either has on the
respect to the interrelationship through the period of other
hospitalisation to home and subsequent infancy
Be familiar with the following:
 effects of maternal drug dependency
 immediate neonatal care
 bonding, rooming in
 neonatal examination
 screening
 post (early) discharge care
 breast feeding in detail, continuance
 breast problems, infections
 formula feeding, special needs
 puerperal complications
 family adjustment
 maternal exhaustion, anxiety
 week examination (NH&MRC Guidelines)
 bottle feeding
 SIDS prevention and management
4 Infant, Toddler and School-Age Years

Demonstrate an understanding of the extended Act as an advocate for the developmental and health
professional and ethical role of the doctor in caring for needs of children and adolescents in the context of their
children of infant, toddler and school-aged years in rural family and community
and remote communities
Be cognisant, familiar and competent in the management
of conditions included in the ''new morbidity''
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Identify and manage the child or young person at risk or

in a situation of abuse, violence, neglect, homelessness
or accidental injury
Appreciate the legal implications of suspected emotional,

physical and sexual abuse or neglect of children or
young people, with particular reference to mandatory
reporting
Be familiar with problems common enough in

presentation during the infant, toddler, school-age and
adolescent years to warrant management in general
practice
Understand the importance of the school milieu in the

child's life and know when and how to liaise with school
and education department staff in the management of
problems
Understand the significance of alienation from school as

a major health issue
Understand the importance of physical achievement to

children, and the principals of fitness and injury treatment
and prevention, utilising available practitioners including
podiatrists, orthotists, physiotherapists and chiropractors
Understand:
Demonstrate competence in the recognition and  particular facets of abuse
management of childhood abuse in its various forms,  effects of parental rejection
together with an understanding of medico-legal  effects of domestic violence
obligations  effects of family breakdown
 effects of neglect of child
 effects of physical abuse
 effects of emotional abuse
 effects of sexual abuse/incest
 Munchausen's by proxy
Be aware of community resources to assist in the

management of childhood abuse, in the context of
concurrent State Legislative requirements
Competently manage specific developmental issues and

psychological issues of this age group including:
Develop a capacity to diagnose and treat (whether  normal and abnormal growth and development,
unassisted or in conjunction with healthcare networks), failure to thrive
the common morbidities of infants, toddler and children  growth velocities in early life
of school-aged years, to deal with/or prevent the  the parent held record
prevalent morbidities of that region  the inter-relationship of physical and mental well-
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being
 role of achievement
 early detection and management of vision and
hearing problems
 behaviour
 normal versus 'problem'
 the social context
 at stage of development
 disruptive children
 disorders, ADHD
 autism spectrum disorder
 sleep disorder
 the crying baby
 oppositional behaviour and alienation
 disability
 learning: specific/general
 intellectual, subnormality
 physical
 language disability
 family development and dynamics
 effects on child
 parental mood disorder
 parental substance use
 the effects of smoking
 childhood caffeine use
 high risk families
Know the principles and issues associated with:

 nutritional goals by age group
 flexible feeding patterns
Demonstrate competence in the management of specific  risk factors for deficits
nutritional and physical fitness issues in children of  iron and calcium deficiency
infant, toddler and school-aged years  vegetarian and vegan diets
 food allergy, sensitivity
 fads and beliefs
 age specific exercise
 recreation and fitness
 obesity
Outline the essential features of, cause of, and specific

treatment for the following conditions:
 recurrent viral infections
 croup (acute, recurrent), stridor, laryngomalacia
Demonstrate competence in the management of specific  rhinitis, sinusitis
upper respiratory, mouth, eye and ear conditions in  nasal septal haematoma
children of infant, toddler and school-aged years  epistaxis
 sleep apnoea
 hearing loss
 ASOM, CSOM
 otitis externa
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 cholesteatoma
 stomatitis, thrush, herpes
 coxsackie
 teething
 caries prevention
 tonsillitis
 epiglottitis
 cervical adenopathy
 congenital glaucoma, cataract
 blocked tear duct
 conjunctivitis, infectious, allergic
 unilateral red eye
 retinoblastoma
 amblyopia, squint
 periorbital cellulitis

 recurrent bronchitis
 bronchiolitis
 asthma
 wheeze cough under 3 years
Demonstrate competence in the management of specific  cough
lower respiratory conditions in children of infant, toddler  psychogenic cough
and school-aged years  pneumonia
 atypical pneumonia
 pertussis
 cystic fibrosis
 TB
 Bronchiectasis

 murmurs, innocent and otherwise
 coarctation of the aorta
 supraventricular tachycardia
 abnormal BP
 SBE prophylaxis
Demonstrate competence in the management of specific
cardiac conditions in children of infant, toddler and Outline the essential features of, cause of, and specific
school-aged years treatment for the following conditions:
 abdominal pain
 acute abdomen
 vomiting
 diarrhoea, acute and chronic
 dehydration as a factor in acute illness
 rehydration techniques
 gastro-oesophageal reflux
 pyloric stenosis
gastrointestinal and hepatobiliary conditions in children
 coeliac disease
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of infant, toddler and school-aged years  appendicitis

 hernia
 abdominal mass
 intussusception
 constipation, encopresis
 rectal bleeding
 jaundice
 hepatitis

treatment for the following:
 abnormal genitalia
 fluid, electrolyte imbalance
 hydrocele
 undescended testis (early, late)
 inguinal hernia
 urinary tract infection
 vesico-ureteric reflux
 congenital abnormality UT
Demonstrate competence in the management of specific  acute urinary obstruction
genito-urinary conditions in children of infant, toddler and  glomerulonephritis
school-aged years  nephrotic syndrome
 enuresis
 vulvitis
 labial adhesions
 phimosis, paraphimosis
 torsion of testis
 circumcision
 tumours

 normal skin variation
 aboriginal skin problems
 birth marks
 viral exanthems
 specific
 non-specific
 solar pathology/prevention
 napkin rash
 thrush, tinea, kerion
 eczema, psoriasis
 seborrhoeic dermatitis
dermatological conditions in children of infant, toddler
 scabies, lice
and school-aged years
 molluscum, orf, pityriasis
 perianal streptococcus
 infections, impetigo
 acne
 urticaria
 drug/food rashes
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 septicaemia, meningococcus
Conduct a neurological examination in children
Outline the essential features of, causes of and specific

treatments for headache

treatment for the following conditions
 limp
 perthes
 hip dysplasia
 lower limb problems
 patello-femoral syndromes
Be aware of neurological problems likely to present in  epiphysitis, apophysitis
childhood and how to institute or conduct a management  soft tissue trauma
plan as necessary  minor dislocations
 progressive muscular weakness
 sepsis, bone/joint infections
Demonstrate competence in the management of specific  sports injury and prevention
musculoskeletal problems in children of infant, toddler
and school-aged years Outline the essential features of, cause of, and specific
 measles, mumps, rubella
 epstein barr disease
 herpes simplex
 haemophilus influenza B
 meningococcus
 varicella, zoster
 streptococcus
 staphylococcus
 chronic viral, HIV, hepatitis
 tropical infestations
 congenital (rubella, CMV, hepatitis)
Demonstrate competence in the management of

common infections contracted by children of infant,
toddler and school-aged years
 normal age haematology
 anaemia
 lymphoma, leukaemia
 inherited conditions
 purpura
 haemophilia
 thallasaemia
 sickle cell disease
 allergies, general concepts, fads
 vasculidities
 angioedema
 kawasaki syndrome
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 autoimmune disease gen.

Demonstrate competence in the management of specific  arthralgia, SLE, RA
Haematological, Immunological and, Rheumatological  immunodeficiency, HIV, AIDS
conditions in children of infant, toddler and school-aged
years Outline the essential features of, cause of, and specific
 newborn screening programs
 diabetes
 systemic effects of oral corticosteroids
 ambiguous genitalia
 stature
Understand the principles and issues relating to:

 patterns of inheritance
 newborn screening
 counselling

endocrine problems experienced by children of infant,
toddler and school-aged years
Outline the principles of and circumstances warranting

genetic screening and counselling
Note
Depending on viewpoint adolescence ranges up to age 23 years or at completion of growth and development. This is
an expanding area of medical interest, and one of vital concern to rural areas, given the higher scale of problems.
Rural resources are likely to remain scant, leaving the GP as a main resource to rural adolescents. There are many
barriers to effective therapeutic relationships with adolescents and this component of training must be viewed as a
priority. The training module must be not less than a full five days' length in total and concentrate on the development
of skills, and the use of family and community networks in assisting adolescents.
5. Adolescence
5.1 Relationships

Comprehensively develop special skills for Possess effective communication strategies, recognising
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understanding and developing effective therapeutic that a young person may feel self-conscious, anxious,
relationships with adolescents, and managing problems alienated, or have difficulty disclosing distress
of adolescence in their various shapes and forms
Understand:
 the main morbidities for adolescents
 the key elements of effective communication and
assisted self-determination in achieving resolution of
these morbidities
Understand the importance of identifying early indicators

of 'at risk' behaviours of adolescents and initiate harm
minimisation strategies
Understand the opportunities for health promotion and

health screening unique to adolescents
Understand the normal striving for independence and the

issues of concern to young people as they progress
through adolescence
Feel confident in helping them and/or their families meet

the consequent challenges
Understand the barriers perceived by adolescents which

may limit access to effective medical care
Understand the effect of peer pressure, school, mass

media and employment prospects on the attitude and
behaviour of adolescents
Understand financial and compliance issues when

prescribing for adolescents
Consider the following issues as they relate to children

and adolescents
 individual rights
 the issue of chaperones
 age of consent
 informed consent
 HIV/AIDS
 confidentiality
 issues of sexuality
 power of guardians over the rights of minors
5.2 Developmental Issues
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Have an understanding of mental, psychological, Discuss the common development issues experienced
physical, sexual, and relational development issues by adolescents including:
experienced during the adolescent years  normal growth and development
 individuation, achieving independence
 sexual maturation
 cognitive development
 self-esteem
 peer issues
 coping with external pressure
 education
 body image
 physical fitness, achievement
 support/alienation from family, school, peers
 oppositional behaviour
 school dysfunction
5.3 Common Problems

Diagnose and manage the common medical problems of Outline the essential features of, cause of, and specific
adolescence treatment for the following conditions:
 acne, seborrhoea, tinea, scabies
 organic weight loss
 sporting injuries, spinal pains
 use of anabolic steroids
5.4 Psychosocial Issues

Identify and assist as appropriate in the management of Identify and discuss the indicators and management
adolescent psychosocial issues strategies for common adolescent psychosocial issues
including:
 interaction of lifestyle issues
 homelessness, risks and reality
 employment and health impact
 risk-taking behaviour
 normal, experimentation, at risk, out of control
 suicidal intention, early intervention
 dysfunctional families
 anorexia bulimia
 self mutilation
 harm minimisation strategies
 drugs
 prescribed, recreational, illegal
 alcohol, tobacco, caffeine
 effects, long and short term
 effects physical and psychosocial
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 IV usage
 demands for prescription
 continuing impact
 drug induced psychosis
 chronic illness and disability
 learning disorders
 developmental disorders
5.5 Communication/Assistance Strategies

Acquire a range of strategies for engaging and assisting Possess skills in a range of adolescent
adolescents communication/assistance strategies including:
 emergency stratagems
 engagement strategies
 confidential history taking
 anxiety, compliance
 family counselling
 organising support
 resources, drop in centres
 the GP in the community
 GP and juvenile justice
 health and imprisonment

Continuously appraise own clinical performance Critically reflect on practice to identify strengths and
Continuously update clinical management in the light of

current knowledge
Undertake clinical audits, including researching

outcomes in order to improve practice

Demonstrate a commitment to the principles of members and other health care providers to provide
coordination of care and the provision of continuity of optimal patient care including appropriate referrals,
care transfers and evacuations

Appreciate the particular need and difficulty in which outline confidentiality and integrity requirements to
maintaining confidentiality in rural/remote communities staff

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Critically reflect on the ongoing development of own
values, attitudes and beliefs
Demonstrate capability to continually enhance personal
and professional function Understand how personal issues may threaten effective
communication, e.g. counter-transference
Enhance the autonomy and personal responsibility of

patients and families
Identify ways in which they may improve health

outcomes for children and adolescents through
enhancing family and social function
Equally find enjoyment, personal satisfaction and growth

from their dealings with children, adolescents, and their
families, and from assisting the passage of an infant or
child through adolescence to adulthood
Utilise opportunities for advocacy on behalf of children

and adolescents
Seek appropriate guidance in any situation where their

professional and ethical duties conflict or are not clear
Contribute to the development of the discipline of

rural/remote general practice by gaining skills in
teaching, research and advocacy aimed at improving the
well-being of children and adolescents
6.5.5 Teaching and Learning Methods
Training environments
Hospital term: A minimum of three months hospital experience in a relevant and accredited setting (*).
This would desirably be late rather than early in the training period to obtain maximum benefit and to ease hospital
concerns as to competence. The term must provide opportunities for hands-on diagnosis and treatment of general
acute paediatric illness, in either a paediatric A/E ward, an acute general paediatric ward, or both as in rural
hospitals. The attachment need not precede a term in supervised general practice. This period has been
recommended by the JCC Paediatrics as being the minimum required to acquire recognition of and a feel for the
seriously ill child. At the same time it is important not to over-emphasise the hospital against the community element
of paediatric training. Accreditation of training posts will be under the supervision of the tripartite JCC. It is recognised
that relevant experience will also be obtained during general A/E and Obstetrics (Neonatology).
Supervised general practice: Standard rural practices are recommended rather than those with paediatric special
interest so as to emphasise the whole family basis of practice. The teacher is not expected to have special skills in
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paediatrics. This term will be supplemented by additional training as follows:
Learning methods
 Special courses (during the GP attachment period).
At the present time all rural trainees should desirably complete and pass the Advanced Paediatric Life Support
Course (APLS). Additionally, ACRRM has identified the need for the development of a substantial course in
adolescent health.
 Modular training courses

Either by attendance or through computer access these courses are an essential component of training.
 Program designed courses run by regional training consortia.
6.5.6 Notes for Teachers and Registrars
Development of this Curriculum Statement

Rural/remote paediatrics has acquired its own characteristics along with the recognition and development of rural and
remote medicine as a distinct and advanced practice area. Various exercises have looked at its general scope and
the JCC Paediatrics further refined this after formation in 1992. The JCCP was part of and closely supervised the
working group that formulated the RACGP Paediatric Core Curriculum. Rural members of the JCCP then formed a
working party, which first produced the ACRRM Paediatric Prospectus and then elaborated for this curriculum
statement. The JCC Paediatrics and the RACP (Div Paediatrics) have approved the contents of this statement. The
underlying philosophy of Australian rural paediatrics was outlined in the RDAA position paper.
Relevant National Health Goals

 Reduce the frequency of preventable mortality (injury, accident, suicide, and aboriginal mortality).
 Reduce the impact of disability, including reductions in the occurrence of new disability (congenital abnormality,
low birth weight, prematurity, chronic illness, intellectual disability, physical disability and learning disorders).
 Reduce the incidence of vaccine preventable disease.
 Reduce the impact of conditions occurring in adulthood which have their early manifestations in childhood or the
teenage years (diabetes, cardiovascular disease, many cancers and mental disorders, the consequences of
poor nutrition and lifestyle problems including substance abuse, unprotected sexual activity, and solar damage).
 Enhance family and social functioning (relevant at every consultation involving a child or young person).
Rural/Remote Paediatric Care

The exigencies of rural/remote paediatric and adolescent care, both community and hospital based, demand some
broadening of scope from the curriculum designed for the training of urban and metropolitan general practitioners. A
balance between training in curative or preventative aspects of care is required to prevent undesirable emphasis on
either aspect. A program of training giving appropriate emphasis to preventative medicine will in the medium to long
term reduce the need for acute care. Adequate training in paediatric and related health care (including prenatal,
perinatal and adolescent health) will help create the necessary basis for a healthy rural population. Careful design of
the overall rural training program will create economy of time and realise the necessary level of education.
Rural Realities
The density of ancillary medical and social services falls with decreasing local population. Childcare networks,
generally integral to appropriate paediatric and adolescent care, have to be modified in the rural setting. The
rural/remote general practitioner is likely to have greater contact with the family as a result of lower provision of such
services. He or she is forced to improvise strategies to manage morbidity and child development effectively and to
foster local and family environments favourable to health promotion and disease outcomes.
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In the absence of a local hospital the rural/remote general practitioner must conduct ambulant management of acute
medical conditions while exercising due discretion as to the advantages and disadvantages of transfer.
When local hospital admission is available the rural/remote general practitioner must have regard for:
 potential untoward effects of admission on the child
 appropriateness of ambulant care
 stabilisation of acute illness
 suitability for local admission
 desirability of tertiary referral, and
 special aspects of transport or retrieval.
Communication
Successful inter-professional and inter-sectoral action for health is based on effective communication. The openness,
trust and quality of communication in the relationships between general practitioner, patient and family are critical to
improving health outcomes. Good communication also enhances parental self-confidence, and the ongoing personal
growth of both the doctor and patient.
Difficulties in Paediatric Presentation

Special skill and experience can be needed to recognise the genuinely sick child. Some problems require immediate
recognition and treatment. Equally, families commonly present seeking medical ‘cures’ for problems which are not
improved by physical or pharmaceutical interventions. Careful management is required to avoid unnecessary
‘medicalisation’, whilst retaining the trust and confidence on which the doctor’s effectiveness depends. In dealing with
genuine acute illness, while avoiding the missed serious diagnosis, a balance must be struck between ambulant and
hospital care so that unnecessary admissions are avoided. An approach that takes into account the sum of
community, family and patient factors involved in the illness is fundamental to rural and remote paediatrics. A
paradigm to illustrate this is available.
Organisation
Effective health promotion, the management of emergencies and the minimisation of preventable morbidity all
depend on good practice and hospital systems and procedures. The best intentions can be undermined by poor
organisation. Careful review and follow up are a key management strategy in the care of children and adolescents.
For those with potentially severe problems, specific strategies and guidelines are essential.
6.5.7 Bibliography
ACRRM Prospectus: Paediatrics 1997.
Australian College of Paediatrics Policy Statement: Delineation of Hospital Roles in providing Paediatric Care Aust.
Paediatr. J (1985) 21. 151-154.
Health Care Policy relating to children and their families. The Association for the Welfare of Children in Hospital. MJA
9.8.75.
Joint Consultative Committee for Paediatrics (JCCP) Position Statement on Paediatric Training. 20.6.99.
RDAA Paediatric Services Position Paper. 1992.
6.5.8 Recommended Texts and Resources
Adolescent Health Module: RACGP In Preparation.

Australian Immunisation Procedures Handbook. NHMRC Latest Edition.
Australian Paediatric Review Quarterly Modules and Publications: Registrars will be placed on mailing list.
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Section Two
Hutson J, Beasley S, Woodward A. Jones Clinical Paediatric Surgery. Blackwell.

Is the Child Seriously Ill: RACGP Educational Module with CD ROM.
General Practice 1996.
Guidelines for screening children NHMRC 1996.
McGrath B, Groom G, Wild A. GPs and Adolescents: dismantling the barriers. Logan Area Division of General
Practice.
National Asthma Campaign: most recent handbook.
RACGP Core Curriculum 1997 pp 138-140 Concentric Sphere Paradigm for Paediatric Management.
Paediatric Handbooks from Major Centres. Latest editions (WCH Adelaide, RCH Melbourne etc).
Paediatrics, Lange Pubs. (latest edition).
Robinson M, Robertson D, Practical Paediatrics Latest Ed. Churchill Livingstone.
Shann Frank, Drug doses, ICU, RCH Melbourne (latest edition).
Working Party
Dr Mike Moynihan (writer)
Dr Stephen Pryde
Dr John Bechtel
Dr David Campbell
Dr Michael Taylor
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6.6 DERMATOLOGY
6.6 DERMATOLOGY
6.6.1 Context

Medical school studies in anatomy, physiology, biochemistry and pathology

Postgraduate adult internal medicine and general practice posts

Principles of rural and remote general practice, adult internal medicine, paediatrics
6.6.2 Background
Dermatology is a common problem found in general practice. It accounts for 6.4% of specialist referrals1, and
specialist dermatologists are concentrated in urban areas. The essentials of dermatology are the same as any other
discipline; a good history, examination and diagnosis followed by the implementation of a management plan.
Dermatology in particular lends itself to pattern recognition and adequate experience and exposure to skin conditions
is essential for learning.
A sound knowledge of the principles of skin disease management is essential for any fellow of ACRRM.
1. Bridges-Webb, et al. Morbidity and treatment in General Practice in Australia, 1990-1991. Med J Aust Supplement 1992: 544 – 6.

The registrar will:
 demonstrate the appropriate knowledge, practical skills and attitudes to provide appropriate dermatological care
in rural/remote practice
 understand the importance of appropriate decision making about local management, consultation and referral for
dermatological conditions, and
activities in the field of dermatology.

1. Basic Knowledge and Understanding of Skin Diseases 5. Specific Skin Conditions
2. Assessment of Skin Diseases 6. Regional Dermatology
3. Investigation of Skin Conditions 7. Professional and Ethical Responsibilities
4. Treatment of Skin Conditions
6.6.5 Content
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6.6 DERMATOLOGY
1 Basic Knowledge and Understanding of Skin Diseases

Demonstrate an understanding of the basic structure of Describe the anatomy of the skin
skin in health and disease
Outline the patterns of skin disease
Outline the scope of skin problems commonly occurring

in rural/remote general practice
2 Assessment of Skin Diseases

Undertake a dermatological assessment in the context of Elicit an accurate and relevant dermatological history
the patient and his/her presentation
Perform an appropriate dermatological examination
observing:
 site
 colour
 surface features
 border
 shape
 distribution
Recognise the signs and symptoms that are beyond

one’s ability to manage and require referral to specialist
care
Outline plan/protocol for referring patients
3 Investigation of Skin Conditions

Outline the indications and appropriate application for Undertake/arrange/interpret appropriate investigations
dermatological investigations including:
 patch testing
Demonstrate skills in competently performing appropriate  mycology
investigations  fungal scraping
 Woods light
Arrange and interpret bacteriology/virology
Perform a skin biopsy including:

 excision
 shave
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6.6 DERMATOLOGY
 curettage
 punch biopsy
4 Treatment of Skin Conditions

Demonstrate the ability to recognise and appropriately Discuss the common pharmacological agents used to
treat common disorders of the skin treat dermatological disorders and their indications and
contraindications including:
 creams, lotions and ointments
 steroid creams/ointments
 moisturisers
 antibacterials/antifungals
 antipsoriatic agents
 systemic treatments
Excise benign and malignant skin lesions including:

Demonstrate expertise in the treatment of benign and  lipomata/sebaceous cysts
malignant skin lesions  subcutaneous foreign bodies
Perform ellipse excisions
Perform flap repairs
Perform skin grafts
Perform cryotherapy of skin lesions and demonstrate an

understanding of associated medico-legal implications
5 Specific Skin Conditions

Demonstrate competence in the diagnosis and Outline the essential features of, cause of, and specific
management of common skin disorders treatment for the following conditions:
 eczema (dermatitis) – atopic, discoid,
 astaetotic, stasis
 lichen planus
 psoriasis
 pityriasis rosea
 erythema multiforme
 urticaria
 vasculitis
 photosensitivitiy
 acne
 rosacea
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6.6 DERMATOLOGY
Outline the essential features of, cause of,

Demonstrate competence in the diagnosis and and specific treatment for the following skin
management of skin infections infections:
 viral
 viral Warts
 molluscum contagiosum
 herpes simplex
 herpes zoster
 HIV
 bacterial
 erysipelas/cellulitis
 staphylococcal infections
 folliculitis
 pitted keratolysis
 erythrasma
 syphilis
 impetigo
 fungal
 candidiasis
 tinea
 pityriasis versicolor
 insects
 scabies
 lice
 flea bites
Recognise and distinguish between:

 ephelides
Demonstrate familiarity with sun damaged skin  solar lentignes
 solar elastosis
 solar keratoses
 sun related skin malignancies

treatment for the following skin tumours:
 non-melanocytic:
 benign:
 seborrheic keratosis
management of skin tumours
 skin tags
 keratoacanthoma
 premalignant:
 solar keratoses
 malignant:
 basal cell carcinoma
 squamous cell carcinoma
 Bowen’s disease
 potential keratoacanthoma
 melanocytic:
 melanocytic naevi
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6.6 DERMATOLOGY
 malignant melanoma

treatment for systemic diseases with possible cutaneous
associations:
 systemic malignancy
 metabolic diseases
Demonstrate competence in the diagnosis and  endocrine disorders e.g. diabetes, thyroid,
management of cutaneous manifestations of systemic Cushings, Addison’s
disease  gastrointestinal disorders
 Paget’s disease
 extra-mammary Paget’s disease
Consider
 pruritis gravidarum
 prurigo of pregnancy
 pruritic urticarial papules and plaques of pregnancy
 pruritic folliculitis of pregnancy
Demonstrate familiarity with rashes related to pregnancy Outline the essential features of, cause of, and specific
treatment for leg ulcers

management of leg ulcers
6 Regional Dermatology

Demonstrate competence in the diagnosis and Describe the anatomy of hair
management of specific dermatological conditions
associated with hair Outline the anatomical considerations, specific
diagnostic tests and treatment for:
 hair loss – diffuse, localised
 alopecia areata
 alopecia totalis
 trichotillomania
 traction alopecia
 scalp ringworm
 lichen simplex
 psoriasis
 excessive hair growth, aetiology, differences
 hirsutism
 hypertrichosis
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6.6 DERMATOLOGY
Describe the anatomy of nails
Demonstrate competence in the diagnosis and Outline the anatomical considerations, specific
management of specific dermatological conditions diagnostic tests and treatment for:
associated with nails  nail pitting
 nail ridging
 nail discolouration
 nail plate thickening
 tinea
 onychogryphosis
Recognise nail changes that occur due to:

 psoriasis
 dermatitis
 paronychia
Recognise, distinguish between and treat:

Demonstrate competence in the differential diagnosis of  irritant dermatitis
‘Nappy Rash’  candida
Recognise and appropriately manage:

 rosacea
 seborrhoeic, perioral, contact dermatitis
Demonstrate competence in the differential diagnosis of
 fungal infection
facial rashes
 systemic and discoid lupus
 erythematosis
Consider and discuss:

 contact irritant dermatitis
 contact allergic dermatitis
 endogenous eczema
Demonstrate competence in the differential diagnosis of  fungal infection
rashes on the hands  psoriasis

Appraise own clinical performance Critically reflect on consultations to identify strengths and
maintaining confidentiality in rural/remote communities which outline confidentiality and integrity requirements to
staff

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6.6 DERMATOLOGY

Demonstrate an awareness of the differing resources in
rural/remote communities and ability to improvise when
necessary
Outline strategies for self care and self reliance network
Working Party
Dr Chris Pearce (writer)
Dr Nigel Bacon (writer)
Dr Michael Mackay
Dr Tom Doolan

Dr Ken Pearson
Dr Ian Jones
Dr Robert Sinclair
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6.7 EMERGENCY MEDICINE
6.7.1 Context
One year of general hospital experience and six months in rural or remote general practice. Australian graduates
completing Postgraduate years' 1 and 2 will have Accident and Emergency experience. This and Accident and
Emergency in an approved Accident and Emergency Department for other registrars will be accepted as prior
experience.

Registrars must obtain at least three months experience in an approved emergency medicine department. At some
stage during training, registrars must also successfully complete the emergency courses required to meet ACRRM’s
completion of training requirements.

Acute resuscitation, airway management and retrieval are covered in detail in the Anaesthetic Curriculum Statement,
which should be read and conducted in tandem with this section of the course. Paediatric and neonatal emergencies
are covered in the Paediatric Curriculum Statement. Obstetric, medical, psychiatric, ENT, and ophthalmic
emergencies are covered in their respective curriculum statements.
6.7.2 Background
The full range of emergencies may present in the rural and remote contexts. However, it is not expected that
FACRRM registrars will have seen the full range of emergencies comparable to, for example, FACEMs. It is
envisaged however that during the period of rural registrar training and other hospital work, sufficient experience will
be gained and a sufficient range of skills acquired to allow the registrar to competently manage emergencies as they
occur, if necessary in telephone or videoconference consultation with advising rural colleagues and specialists.
This curriculum statement of necessity overlaps with other procedural and non-procedural disciplines and
unnecessary duplication of material has been avoided.

The registrar will:
 demonstrate the capacity to perform the standard logical response to emergency life-threatening situations
 demonstrate the capacity to proceed from primary survey and emergency resuscitation to secondary survey and
definitive or temporising management of identified problems
 be fully cognisant of the rural issues and processes involved and in acting only within personal capabilities know
how to obtain advice and assistance from referral centres and organise in conjunction with them safe and
effective retrieval to definitive management as indicated
 be capable as a member and where necessary leader of accident and emergency teams
 know what to do and what equipment to take when summoned to an out of hospital emergency
 demonstrate a broad knowledge of the management of emergencies likely to present in the isolated rural setting
and the capacity to generalise from experience to emergencies not yet encountered, and
 be aware of the organisational aspects of rural hospitals necessary to maintain an effective emergency capacity.
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1. Background Knowledge 12. Toxicological Emergencies

2. Dealing with Acute Emergencies 13. Paediatric Emergencies
3. Airway Emergencies 14. Metabolic/Endocrine Emergencies
4. Breathing Emergencies 15. Analgesia/Anaesthesia
5. Cardiac and Circulation Emergencies 16. Psychiatric Emergencies
6. Neurological Emergencies 17. Acute Infectious Disease Emergencies
7. Orthopaedic Emergencies 18. Medical Imaging
8. Wounds, Lacerations and Burns 19. Forensic Emergencies
9. Surgical including Urological Emergencies 20. Retrieval in Emergency Situations
10. Ophthalmological Emergencies 21. Disaster and Multi-Trauma Emergencies
11. E.N.T. Emergencies 22. Professional and Ethical Responsibilities
6.7.5 Content
1. Background Knowledge

Revise and develop a basic knowledge of anatomy and Understand the basic pathophysiology of cardiac arrest
physiology relevant to the emergency setting and the factors leading to circulatory and respiratory
failure
Describe the basic anatomy of the airway, circulatory

system in relation to life threatening conditions
Describe relevant anatomical aspects of the neurological

and musculoskeletal systems in relation to medical and
surgical conditions
Outline the important age-specific differences and the

anatomy and physiology of the child relevant to
emergencies
Outline the essentials of acid-base balance and fluid and

electrolyte management in emergencies
2. Dealing with Acute Emergencies

Demonstrate a detailed appreciation of the steps Undertake the following basic skills:
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involved in the management of an acute emergency,  basic life support skills

proceeding logically through life support while advancing  how to deal with outdoor emergencies
towards definitive diagnosis and management of
underlying injury and disease Undertake the following post-basic skills:
 give telephone advice to transporting persons
 make appropriate pre-arrival preparations
 conduct initial resuscitation following the ABC
algorithm
 make a primary survey
 conduct further resuscitation as indicated
 make a secondary survey
 conduct necessary investigations
 initiate definitive treatment where indicated
 initiate consultation as indicated
 conduct retrieval as indicated
3. Airway Emergencies

Demonstrate competence in the diagnosis, treatment Perform the following basic procedures while maintaining
and management of airway emergencies including: control of Cervical Spine:
 airway opening manoeuvres  head tilt
 inhaled foreign bodies  chin lift
 epiglottitis  jaw thrust
 croup  oropharyngeal airway
 burns  nasopharyngeal airway
 tamponade  airway suction
 use of nebulised adrenaline
Demonstrate familiarity with the special considerations Perform the following post-basic skills:
for facial and airway trauma  insertion and use of LMA
 endotracheal intubation
 rapid sequence induction for intubation
 needle cricothyroidotomy
 jet insufflation
4. Breathing Emergencies

Demonstrate competence in the diagnosis, treatment Perform the following basic procedures:
and management of breathing emergencies including:  expired air resuscitation
 apnoea  bag/mask ventilation
 severe asthma  pulse oximetry
 pulmonary oedema  oxygen therapy including non-rebreathing oxygen
 pulmonary embolus mask and CPAP/BIBPAP
 tension pneumothorax  nebulisation therapy
 multiple rib fractures  administration of adrenaline for severe
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 sucking chest wounds asthma/anaphylaxis

 lateral axillary compression for asthma
Note: See also Adult Internal Medicine and General
Surgery Curriculum Statements Perform the following post-basic procedures
 needle thoracocentesis
 intercostal catheter placement
 intercostal anaesthetic block
 dress sucking chest wound
 intercostal catheter insertion
 taking and analysis of arterial blood gases
5. Cardiac and Circulation Emergencies

Demonstrate competence in the diagnosis, treatment Undertake the following basic skills:
and management of cardiac and circulation emergencies  basic cardiac arrest protocol
including:  12 lead ECG interpretation
 all forms of shock including hypvolaemic, cardiac,  venous cutdown
septic, neurogenic and anaphylactic  use of fluid and blood resuscitation
 acute myocardial infarction  thrombolytic therapy
 cardiac tamponade  administration of ionotropes
 dysrhythmia  antiarrhythmic therapy
 the acutely ischaemic limb  needle pericardiocentesis
Note: See also Adult Internal Medicine Curriculum Undertake the following post-basic skills
Statement  advanced cardiac arrest protocol
 emergency cardioversion
 central line insertion
 intraosseous needle insertion
 cubital fossa long line insertion
 advanced fluid resuscitation techniques
6. Neurological Emergencies

and management of neurological emergencies including:  use of Glascow Coma Scale
 coma  initial assessment of head trauma
 stroke  care of cervical spine injury or potential injury
 altered mental status  care of unconscious patient
 seizures  care of patient with altered conscious state
 head trauma  management of status epilepticus
 subarachnoid haemorrhage  interpretation of CT scans
 meningitis
 status epilepticus
Demonstrate competence in the treatment and Undertake the following post-basic skills:
management of severe head injuries, including airway
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and ventilatory management  lumbar puncture

 burr hole
Administer thrombolytic therapy
7. Orthopaedic Emergencies

Demonstrate competence in the diagnosis and Perform the following basic skills:
management of orthopaedic emergencies including:  bandaging
 simple injuries  splinting
 potential neurovascular compromise  plastering
 fractures, simple and compound  joint aspiration
 dislocation
 spinal injuries Undertake the following post-basic skills:
 hand injuries  emergency management of compound wounds
 compartment syndrome  emergency reduction of fractures for neurovascular
 septic arthritis compromise
 escharotomy and fasciotomy
Note: See also General Surgery Curriculum Statement  release of compartment wounds
 amputation of digit
 Xray interpretation especially spine, skull and pelvis
8. Wounds, Lacerations and Burns

Demonstrate competence in the diagnosis, treatment Perform the following basic skills:
and management of wounds, lacerations and burns  use of prophylactic antibiotics as per National
antibiotic guidelines
Note: See also General Surgery Curriculum Statement  local anaesthetics infiltration of wound
 primary closure techniques
 secondary and delayed primary closure
 drainage of abscesses
 administration of tetanus toxoid and tetanus
immunoglobin
 wound dressing
Perform the following post-basic skills:

 wound cleaning and debridement
 subcuticular wound repair
 layered wound closure
 simple plastic techniques
 assessment of burns in children
 early management of severe burns
 fluid therapy in burns
 chemical and electrical burns therapy
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9. Surgical including Urological Emergencies

Demonstrate competence in the assessment, Perform the following basic skills:
management where indicated, and referral or transfer of  diagnostic approach to the acute abdomen
surgical emergencies particularly with regard to:  assessment of abdominal trauma
 acute abdomen  urethral catheterisation
 abdominal and pelvic trauma  suprapubic catheterisation
 urinary retention
 urological trauma Perform post-basic skills as directed by the General
Surgery Curriculum Statement
Note: See also General Surgery Curriculum Statement
10. Ophthalmological Emergencies

Demonstrate competence in the diagnosis, treatment Perform the following basic skills
and management of ophthalmological emergencies  fundoscopy
including:  irrigation of the eye
 red eye  topical anaesthesia
 acute loss of vision  fluorescein staining
 painful eye  slit lamp examination
 corneal foreign bodies  tonometry
 corneal abrasions
 penetrating/contaminated injury Perform the following post-basic skills:
 corrosive injury  emergency management acute glaucoma
 acute chalazion  removal of corneal foreign body and rust
 glaucoma  emergency management of penetrating injury
 initial management of infraorbital fracture
Note: See also Ophthalmology Curriculum Statement
11. E.N.T. Emergencies

and management of ENT emergencies including:  nasal packing or nasal balloon placement
 anterior and posterior epistaxis  cautery of Little's Area
 aural and nasal foreign bodies  removal of foreign bodies from ear and nose
 quinsy
 midface fracture (see airway) Undertake the following post-basic skills:
 fractured nose  aspiration of quinsy
12. Toxicological Emergencies
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Demonstrate competence in the diagnosis, treatment Undertake the following basic skills
and management of toxicological emergencies including:  administration of activated charcoal
 drug overdose  use of venom detection kit
 other poison ingestion  administration of anti-venom
 terrestrial and marine envenomation  administration of antidotes
 nasogastric and orogastric tube insertion
 gastric lavage if indicated
Undertake the following post-basic skills:

 whole bowel irrigation if indicated
13. Paediatric Emergencies

Demonstrate competence in special considerations for Undertake the following basic skills:
the treatment and management of emergencies in  venepuncture, venous access
children especially with respect to:  intraosseous infusion
 early management of severe trauma including spinal  nebulisation therapy
cord injury without radiological abnormality  nasogastric catheterisation
 burns  assessment of hydration
 cardiac arrest/arrhythmia  fluid and electrolyte management
 respiratory emergencies  suprapubic aspiration
 hypovolaemic conditions
 infections Undertake the following post-basic skills:
 metabolic emergencies  airway management, intubation
 non-accidental injury  cardioversion
 abuse situations  acid base management
 neonatal resuscitation  neonatal intubation, umbilical catheterisation
 removal of foreign body
Note: See also Paediatric Curriculum Statement
14. Metabolic/Endocrine Emergencies

and management of metabolic/endocrine emergencies  insulin infusion
including:  intravenous potassium replacement
 diabetic ketoacidosis  IV fluids for endocrine emergencies
 hypoglycaemia
 hyperosmolar coma
 hyperkalaemia
 hypocalcaemia
 Addisonian crisis
 hypothermia
 hyperthermia
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Note: See also Adult Internal Medicine Curriculum

Statement
15. Analgesia/Anaesthesia

Demonstrate competence in the use of analgesia and Perform the following basic skills:
anaesthesia in the treatment and management of  administration of nitrous oxide
emergencies  administration of intravenous analgesics and
sedatives
Note: See also Anaesthesia Curriculum Statement  administration of topical anaesthesia
 administration of ring blocks
 paediatric conscious sedation
Understand special methods of paediatric pain

management and anxiolysis
Perform the following post-basic skills:

 Biers Block
 Femoral Nerve Block
 use of Ketamine
 Crash induction
 use of neuoleptic agents
16. Psychiatric Emergencies

Demonstrate competence in the diagnosis of psychiatric Demonstrate the following basic skills:
emergencies including:  assessment of risk
 psychosis  engagement
 mania  acute counselling
 violence/aggression  use of rapid acting anti-psychotics
 suicide  use of other medication
 depression  use of relevant legislation for compulsory admission
 grief  co-management with psychiatric team
 adolescent crisis
 acute staff burnout Ddemonstrate the following post-basic skills:
 staff debriefing
Note: See also Psychiatry Curriculum Statement
17. Acute Infectious Disease Emergencies
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Demonstrate competence in the diagnosis and Demonstrate the following basic skills:
management of acutely or potentially life-threatening  application of infection control procedures
infections particularly:  public health reporting procedures
 meningitis  management of contact persons
 septicaemia
 neonatal infection Undertake the following post-basic skills
 febrile convulsion  acute resuscitation (see cardiac and circulation)
 the potentially septic child
Note: See also Adult Internal Medicine and Paediatric

Curriculum Statements
18. Medical Imaging

Be competent in the interpretation of x-rays, Cat scans, Demonstrate the following basic skills:
and ultrasound where pertinent.  chest, spine, abdomen extremity x-ray
 cranial CT
Note: See also Radiology Curriculum Statement
Demonstrate the following post-basic skills:
 emergency use of contrast
 diagnostic ultrasound in pregnancy
19. Forensic Emergencies

Demonstrate competence in the management of acute Demonstrate awareness of legal requirements
forensic presentation particularly with respect to:
 victims of sexual assault Understand basic forensic examination protocol
 child abuse
20. Retrieval in Emergency Situations

Be competent in the execution of emergency Ensure patient stabilisation particularly in terms of
management in consultation with referral centres haemodynamics, oxygenation and acid/base balance
(proceeding to retrieval when the necessity is agreed)
Ensure proper monitoring
Be competent to set up and supervise retrieval and Ensure proper access/egress for all systems in
stabilise the patient in preparation for transfer particular:
 airway protection
 adequate venous access
 naso/orogastric intubation
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 urinary catheterisation
 spinal stabilisation
 stabilisation of injuries and fractures
Observe proper aeromedical principles
21. Disaster and Multi-Trauma Emergencies

Be competent to help plan for or assist and participate in Be aware of the relationships between members of
a response to a disaster or multi-trauma emergency services, police and health workers at
accident sites
Know the principles of triage, prioritisation of patients for

resuscitation, and resource allocation
Be aware of the useful contents and general layout of

Be competent to contribute to the formulation of a emergency and retrieval kits
disaster management plan for a given rural/remote
geographical area




network
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Working Party
Dr Michael Glover
Dr John Biggins
Dr Malcolm Fairleigh
Dr Kennedy
Dr Kenneth McCallum
Dr Hal Rikard-Bell
Dr George Somers
Dr Barry Trewren
Dr Mike Moynihan
Dr Ross Wilson

Dr Tom Doolan
Dr John Hadok
Dr Alastair McInnes
Dr Daryl Pedler
Dr Nicholas Williams
Dr Ken Pearson
Dr Leon Malzinskas
Dr Dan Pettersson
Dr Dan Manahan
Dr Neil Provis
Dr Shane Brun
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6.8 INFORMATION MANAGEMENT AND INFORMATION TECHNOLOGY
6.8.1 Context

Basic understanding and experience in using a personal computer and computer databases

Rural or remote general practice attachment

Management, research and evidence based medicine

The registrar will:
 demonstrate the ability to use information technology (IT) to aid in information exchange associated with patient
management
 demonstrate the ability to use various applications of IT in the practice of rural and remote medicine and for
ongoing professional development purposes
 demonstrate the ability to use technology to aid in differential diagnosis, the development of management plans,
electronic prescribing, and storing relevant patient information which can be communicated as appropriate
 demonstrate the ability to electronically order and communicate the findings of appropriate investigations
 understand the role of IT in emergency management, particularly pertaining to rural and remote general practice
 understand the advantages of using computers to maintain patient records in a regular and orderly manner, and
 demonstrate personal confidence and competence in the use of current medically related IT modalities.
1. Communication Tools 4. Information Management

2. Computer Skills 5. IT Administrative Applications
3. Computerised Patient Care
6.8.4 Content
examples of behaviours which indicate the objective has been achieved.
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1. Communication Tools

Effectively use standard communication technologies to Possess basic skills in using email:
aid in information exchange associated with patient  email settings
management and professional development including:  setup
 telephone/mobile phone (including teleconferencing,  accounts management
voicemail, text messaging)  address book
 fax  attachments
 email  multiple addresses
 satellite transmissions  e-groups
 internet and intranet  etiquette and privacy issues
Utilise standard communication tools as necessary for:

 specialist consultation
 communication with other doctors and allied health
professionals, hospitals
 electronically ordering appropriate pathological,
radiological or other investigations
 coordination of trauma/emergency care
 teleconferencing
 transmitting data and images
 transmission of ECG (fax)
 education
Utilise the Rural and Remote Medical Education Online

(RRMEO) website (www.rrmeo.com) communication
tools as appropriate to:
 communicate with peers
 participate in clinical discussion forums
Understand the potential and limitations of the various

Demonstrate familiarity with advanced communication applications of advanced communication technologies in
tools which may be used to assist with patient rural/remote general practice including:
management and professional development including:  telemedicine
 videoconferencing  terminology
 digital medical photography  equipment
 handheld computers  specialist consultation
2. Computer Skills

Recognise the need for self sufficiency in dealing with IT Develop an understanding of the range and accessibility
technical issues in rural and remote areas of local IT support resources including:
 Divisions of General Practice
 hospitals
 Community-based Health Organisations
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 local IT companies
Possess a basic knowledge of common terminology and

the role of the standard components of a medical
Demonstrate basic computer system knowledge and practice computer system such as:
skills  desktop/laptop
 modems
 CD-ROM
 DVD
 hard-drive
 network
 back-up
 hardware/software
 scanner
 printer
Possess a basic understanding of:

 how to choose a computer system
 how to choose and install software
 how a network functions
Demonstrate familiarity with commonly used operating

systems
Demonstrate familiarity with commonly used software

such as:
 word processors
 spreadsheets
 graphics
 databases
Possess basic keyboard proficiency
Demonstrate familiarity with basic computer

protection/security and maintenance procedures
including:
 virus scanning
 scandisk
 hard disk compacting and
 defragmentation
 passwords
 firewalls
 power protection e.g. UPS
Possess basic skills in using the internet including:

 connecting to the internet
 evaluate options in choosing an Internet Service
Provider (ISP)
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Understand basic internet terminology such as:

 web server
 web page/web site
 search engine
 hyperlinks
 HTML
Effectively use a search engine to find required

information
Effectively access electronic information to enhance
clinical decision making Utilise various credible electronic information sources
such as:
 professional organisation information e.g. ACRRM,
RDAA
 journals, online textbooks, clinical research studies
 literature search databases e.g. Medline
 evidence-based clinical information
 evidence based patient education information e.g.
the ‘HealthInsite’ website
 relevant government information
 discussion forums
 local and national medical networks
Effectively use CD-ROM and/or internet based

interactive learning resources to acquire and enhance
Utilise electronic educational resources for professional knowledge and skills (such as RRMEO)
development purposes
3. Computerised Patient Care

Demonstrate competence in the use of electronic patient Understand the concept of ‘paper-less’ medical care
care systems
Efficiently use an electronic prescribing and electronic
medical record system
Understand the advantages and disadvantages of using

such electronic systems compared to manual (paper
based) systems
Understand and manage issues related to ‘electronic’

patient confidentiality, security and privacy:
 use of data encryption software e.g. Public Key
Infrastructure (PKI)
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4. Information Management

Demonstrate competence in managing information to Understand the principles of using patient
assist in promoting improved clinical, patient and practice information databases for activities such as:
outcomes  patient registers including:
 age, sex and disease
 patient recall and reminder systems
 electronic diagnosis and treatment support
including:
 drug-drug interaction alerts
 patient medication and clinical histories
 contribution to research/clinical audit activities
 health data management for the community e.g.
incidence of diabetes or tuberculosis in a community
5. IT Administrative Applications

Demonstrate an understanding of the potential uses of Demonstrate familiarity with the principles of electronic
information technology for managing administrative financial and management systems such as:
processes within the practice/organisation  electronic funds transfer at the point of service
 payments to doctors
 payment of insurance rebates to patients or
doctors
 government IT systems e.g. Easyclaims,
Mediclaims
 automated ordering of medical and other
 practice supplies
 payment of staff wages and accounts
 patient appointments
 electronic handling of correspondence
Demonstrate familiarity with, and the mechanism for

accessing the Australian Childhood Immunisation
Register
Working Party
Dr Stephen Holmes
Dr Alex Bennett
Dr Pat Giddings
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Dr Chris Harrison

Dr Ewen McPhee
Dr Les Robert-Thompson
Mr Mark Brommeyer
Dr Peter Baker
Dr John Togno
Ms Vicki Sheedy
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6.9 MANAGEMENT
6.9 MANAGEMENT
6.9.1 Context

Medical school level training in communication skills, interview techniques

Rural general practice/health centre attachment

Information management, strategic skills in rural general practice
6.9.2 Background
Management training is a vital part of the ACRRM Primary Curriculum, no matter which mode of practice or setting
the registrar ultimately chooses. Models of general practice in rural and remote Australia include private fee-for-
service general practice, salaried work for Community Controlled Health Organisations, salaried MO in a district or
regional hospital, with or without the right of private practice and so on. Professional activities may also include
involvement with a local division of general practice, a professional body or medico-political organisation.
Thus competencies in the many aspects of management are essential tools to enable doctors to achieve outcomes
within and through the myriad of organisations they are involved with. These elements include leadership,
administration, organisation, continuous quality improvement, marketing, and financial management. These
competencies can be applied to patients, colleagues, staff, teams and organisations including practices.

The registrar will:
 demonstrate the essential knowledge and skills associated with the management, organisation and operation of
a health organisation
 understand the differing organisational structures that are common to rural/remote health organisations
 understand the information management systems commonly used by various health organisations in the
rural/remote setting
 demonstrate the basic skills necessary to manage finance effectively and efficiently
 demonstrate the basic skills necessary to manage human resources
 demonstrate the basic skills necessary to manage personal resources including funds and provision for personal
self care and self-development
 demonstrate the ability to work with practice staff and other health professionals to optimise the delivery of
patient care, and
 demonstrate a commitment to continuous quality improvement and maintaining standards of practice established
by relevant external bodies so as to optimise quality of care.
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6.9 MANAGEMENT
1. Management Principles 7. Patient Services and Practice Image

2. Practice Organisation 8. Information Systems
3. Operations Management 9. Professional Resources
4. Human Resource Management 10. Organisation Development
5. Financial Management 11. Personal Financial Management
6. Professional Activities
6.9.5 Content
1. Management Principles

Demonstrate an understanding of the general principles Undertake strategic planning
of managing a health organisation
Describe the roles and responsibilities of management
and leadership such as:
 basic principles of quality management
 leadership theory
 team development
 delegation
Negotiate and manage budgets, resources, and

organisational performance
Work with and involve practice staff and others to

facilitate a team approach to quality patient care
Adapt appropriately to change in the health care

environment
2. Practice Organisation

Determine the style and structure of general practice Assess practice location
they wish to pursue  part of the country
 size and type of community
 one practice town/multi-practice town
Understand the practical, financial, administrative and

legal implications of the range of practice and
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employment models:
 traditional solo or group practice
 partnerships
 associateships
 employee
 contract
 locum
 blended private and public
 Corporations
 government/public health positions
 education/academic positions
3. Operations Management

Establish and maintain systems for the operation of an Implement policies and procedures for organisational
effective organisation processes including:
 line of responsibility
Note: See also Information Management and Information  communications
Technology Curriculum Statement  patient flow and scheduling
 front desk duties
 phone calls
 handling of referrals, reports, letters
 screening, recall systems
 infection control
 complaints
Demonstrate awareness of resources available through

professional organisations on operation management
topics e.g. on developing procedures and the ability to
access such information as the need arises
Implement systems to monitor operational performance
Explore opportunities to improve operational

performance
Understand and navigate the relevant levels of

bureaucracy both within and external to the organisation
Develop appropriate systems for the management of

Appropriately maintain medical records medical records such as:
 storage and filing
 indexing and coding
 confidentiality, security
 incorporating clinical results/reports/correspondence
 risk management in backup (onsite and offsite) and
restoration of data
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6.9 MANAGEMENT
4. Human Resource Management

Demonstrate skills in human resource management Discuss staff management principles
Establish effective work relationships with staff and

colleagues through appropriate leadership, support,
communication, negotiation and decision making
Develop policies and procedures for staff such as:

 recruitment
 appraisal/productivity assessment
 staff development/training
 contracts/remuneration
 disciplinary guidelines
 holiday/sickness/sabbatical/CME leave entitlements
Understand the importance of teambuilding and

teamwork for successful operation of the health
service/practice
Understand the principles and apply techniques of

conflict resolution in managing conflicts with patients,
staff and colleagues
Identify and facilitate special skills of individual staff

members and encourage the dissemination of
knowledge within the staff team to overcome the
consequences of the loss of key staff
Outline strategies for practitioner self care and self

management
Outline means of access to relief staff/locums
Understand statutory and regulatory requirements

relating to staff including:
 OH&S Legislation
 Trade Practices Act
 Equal Opportunity Legislation
 Privacy Act
 Medical Practitioners Act - Workers Compensation
 Workplace Relations Act
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6.9 MANAGEMENT
5. Financial Management

Demonstrate skills in monitoring the financial Develop a basic business plan for the organisation
performance of the organisation
Understand the economic concerns in the administration
of the organisation
Identify sources of income and areas of cost
Keep good financial records
Undertake stock control/inventory
Prepare an annual budget including a cash flow analysis
Interpret basic financial statements e.g. profit and loss

and balance sheet and to be able to understand the
basis of depreciation and depreciation schedules
Undertake credit control
Effectively manage:
Demonstrate skills in the financial management of the  insurance needs
organisation  payroll systems
 profit sharing
 purchase of equipment/stock
 billing procedures
Effectively identify and utilise structures and financial

rewards/incentive programs such as:
 Enhanced Primary Care item numbers
 Practice Incentive Program
 Rural Retention Scheme
 other remuneration packages/programs available to
the practitioner
Effectively manage practitioner investment in the practice

and returns on investment
Identify the types of finance available to the organisation

Demonstrate skills in managing the flow of money
through the organisation Understand day-to-day cash flow management
Understand patient fees and fee collection processes
Utilise service companies to control finance as
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6.9 MANAGEMENT
necessary
6. Professional Activities

Demonstrate a broad knowledge of the function of Be familiar with the role and responsibilities, of relevant
relevant professional and medico-political organisations local, state and national professional and medico-political
and their members organisations
Participate effectively as a member of a

professional/medico-political organisation, understanding
the:
 role and responsibilities of the Board
 role and responsibilities of a chairperson
 understand what is meant by "terms of reference"
and how they are developed and applied to
committees
 committee protocol
 meeting protocol
7. Patient Services and Practice Image

Establish mechanisms to optimise patient services Identify and address patient service needs
provided by the organisation
Establish systems to receive and respond to patient
feedback and complaints
Discuss methods of continuous quality improvement

applied within the organisation:
 clinical/management audit
 performance appraisal benchmarked against local
and national standards
 practice accreditation/hospital ACHS accreditation
 evaluate objectives of accreditation
requirements and follow through accreditation
processes deemed appropriate to the location
Explore opportunities to improve patient satisfaction
Outline principles for effective marketing and promotion Understand basic marketing concepts
of the organisation as appropriate
Develop and implement ethical marketing strategies to
promote the organisation
Evaluate general marketing performance
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6.9 MANAGEMENT
8. Information Systems

Demonstrate a basic understanding of the range of Discuss in general terms:
information systems available and their uses in assisting  information systems – manual and electronic
with the management of the organisation  information essential for ongoing organisation
management
Note: See also the Information Management and  information for day-to-day management
Information Technology Curriculum Statement  patient information for quality services
 performance information for quality control
9. Professional Resources

Outline how to prudently select and utilise professional Understand the role and function of academic, financial,
advice to assist with the establishment and maintenance political and legal advisers including:
of a successful health organisation  management consultants
 accountants
 solicitors
 financial planning consultants
 practice manager
 Board/committees
 local Division of General Practice
 Rural Workforce Agencies
 ACRRM
 RDAA
 AMA
 MDU
 RACGP
Effectively organise advisers and utilise

recommendations
10. Organisation Development

Outline strategies for facilitating organisation Outline basic concepts of organisation development
development
Utilise organisational and non-organisational resources
for development
Protect resources via insurance
Recognise and manage risk:
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6.9 MANAGEMENT
 implement practices and procedures to minimise risk
Successfully negotiate with national, state and local

government bodies and regional health authorities
regarding the maintenance and development of the
organisation as necessary
Effectively invest in the organisation for development as

necessary
11. Personal Financial Management

Demonstrate skills in personal financial management Effectively manage personal finances:
 debt consolidation
 insurance needs
 taxation
 superannuation
 retirement planning
Outline the range of sources of financial advice
Outline long-term financial plan and describe alternative

investment strategies:
 managed funds
 portfolio management
Demonstrate an understanding of the interplay between

lifestyle, practice and personal financial needs
Consider the issues surrounding family involvement in

financial matters
The content of the above curriculum statement was in part derived from an outline developed by UNE Partnerships
Pty Ltd, the Education and Training Company of the University of New England, Armidale, NSW. The original outline
is copyright to UNE Partnerships.
UNE Partnerships is a Registered Training Organisation (RTO) developing and delivering accredited qualifications
and courses in medical practice management and administration by distance education and face-to-face modes
nationally. For more information, please contact:
Managing Director, Ms Leonie Henschke,

UNE Partnerships Pty Ltd, PO Box U199, University of New England, NSW 2351
ph: 02 6771 1097 fax: 02 6772 5230
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6.9 MANAGEMENT
email leonie.henschke@unepartnerships.com.au
website www.unepartnerships.com.au
ACRRM would also like to thank the following individuals for their valuable contribution to the development of this
Working Party
Dr Pat Giddings
Dr Fred McConnel
Dr Clyde Ronan
Ms Pat Ryder
Dr Jonas Kasauskas
Dr Stephen Webb
Ms Jeanne Webb

Dr John Birss
Dr Andrew Egan
Dr Peter Baker
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6.10 MUSCULOSKELETAL MEDICINE

6.10.1 Context

Some medical schools such as Monash and Flinders include musculoskeletal medicine in undergraduate training.
Basic medical science as taught generally contains most of the elements necessary for an understanding of the
discipline but might need to be revisited while studying the subject. Doctors with general practice experience may
have attended courses available around Australia, especially those organised by the Australian Association of
Musculoskeletal Medicine (AAMM) and the Faculty of Musculoskeletal Medicine, organisations with their roots in
General Practice.

Rural and remote general practitioners may choose to acquire basic knowledge and skills or to extend their
capabilities to treating less common conditions. This curriculum statement provides both a basic outline and a road
map to acquisition of future skills. Because of the lack of basic training generally received in the undergraduate years
some dedicated teaching is essential during the registrar years. There are throughout Australia rural and remote
practitioners trained in and practising musculoskeletal medicine. Therefore it will be possible for training consortia to
arrange courses utilising the expertise of these individuals. A minimum of five days full time teaching is
recommended for practitioners seriously interested. There is a growing catalogue of written and audiovisual materials
available on this subject. In addition, there is a range of postgraduate courses.

Musculoskeletal conditions often mimic other conditions and are dealt with, not always appropriately, by practitioners
of other disciplines such as surgery, orthopaedics, rheumatology, neurology, and neurosurgery, where they constitute
an important component of differential diagnosis. They form a substantial part of sports and rehabilitation medicine
and are of concern in occupational health and safety. They often occur directly or indirectly as a result of other
morbidity, such as menopause. In this area particularly, patients often present with background factors such as
stress, life problems, lack of fitness, obesity and substance misuse and skills in managing these are therefore
required. Patients with these problems often are, or have been, attending alternative therapists.
Sections of this curriculum statement overlap with other curriculum statements, particularly surgery and orthopaedics.
Thus it is recommended that registrars not aiming at rural hospital practice ensure they have orthopaedic skills
including management of simple fractures and dislocations.
Whilst not extending into areas such as sports and rehabilitation, this curriculum statement provides a framework and
skills for these areas.
6.10.2 Background
Musculoskeletal ailments are extremely common in general practice, representing about 12% of all attendances, with
back pain as the third commonest presentation after cough and throat complaints (Murtagh 1999). They can be
difficult without proper training to differentiate from other conditions. Australia has not at the time of writing
recognised Musculoskeletal Medicine (Orthopaedic or Physical Medicine) as a speciality. It is difficult for the rural and
remote general practitioner to know where to send these patients and it is a commonplace that the range of locally
available specialists often does not have the competence to deal especially with what might be problems of
intermediate significance. A few musculoskeletal physicians are to be found in metropolitan centres. Physiotherapists
and other relevant practitioners such as chiropractors and osteopaths are found in larger rural towns. Rural and
remote general practitioners frequently come to the conclusion that it is best to manage these patients themselves
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and moreover advances in musculoskeletal medicine have made it highly desirable that as doctors they have the
skills necessary to make judgements concerning the diagnosis and management of these conditions.
The essentials of Musculoskeletal Medicine are the same as any other discipline; a good history, examination and
diagnosis followed by the implementation of a management plan. Musculoskeletal medicine in particular lends itself
to pattern recognition and adequate experience and exposure to musculoskeletal conditions is essential for learning.
A sound knowledge of the principles of Musculoskeletal Medicine is therefore essential for any fellow of ACRRM. The
discipline as a whole is moving towards evidence based activity and the validation or otherwise of the plethora of
techniques currently used by a huge range of practitioners. In this curriculum statement, Musculoskeletal Medicine is
presented in the general practice context, rather than the spectrum dealt with by musculoskeletal physicians, and
reflects the morbidities more likely to be encountered by the average rural and remote general practitioner.

The registrar will:
 demonstrate appropriate knowledge, practical skills and attitudes to provide diagnosis and care of
musculoskeletal conditions in rural and remote general practice
 understand the importance of appropriate decision making about local management, consultation and referral of
musculoskeletal conditions
 understand the implications of lifestyle factors and patient characteristics in the aetiology and management of
musculoskeletal problems
 demonstrate basic hands-on skills in the treatment of musculoskeletal conditions, and a framework for the
addition to and development of these skills in future years of practice, and
activities in the field of musculoskeletal medicine.
1. Background Knowledge 5.5 Elbow Conditions and Pain in the Arm

2. Assessment of Musculoskeletal Conditions 5.6 Wrist and Hand Conditions
3. Treatment of Musculoskeletal Conditions 5.7 Thoracic Spine Conditions
4. Coordination of Care 5.8 ‘Low Back’: Lumbar Spin and Sacroiliac Joint
Conditions
5. Specific Musculoskeletal Conditions 5.9 Buttock, Hip, Pelvis and Thigh Conditions
5.1 Cervical Spine Conditions 5.10 Knee Conditions
5.2 Cervical Syndromes 5.11 Lower Leg, Ankle and Foot Conditions
5.3 Jaw Conditions 6. Professional and Ethical Responsibilities
5.4 Shoulder Conditions
6.10.5 Content
acquired, while ‘Required Abilities and Skills’ describe and define the specific abilities and skills required and give
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Demonstrate an understanding of the basic principles of Outline the scope of musculoskeletal problems
diagnosis, treatment and management of commonly occurring in rural/remote general practice, in
musculoskeletal conditions particular those affecting:
 school age children
Demonstrate a broad understanding of the variety of  different sporting groups
conditions affecting different age, sex and occupational  different industrial groups especially manual
groups labourers
 women of child-bearing age
 the aged
Understand basic anatomy, physiology and

biomechanics relevant to musculoskeletal disorders
including:
 normal functioning of the axial and appendicular
skeleton and musculature
 pathways of innervation of muscles
 dermatome innervation and trigger point distribution
 functional anatomy of joints
 surface anatomy
Understand the significance of active, passive and

resisted movements in examination, including
neurological testing by resisted movement
Understand the mechanisms, characteristics and

patterns of pain, including:
 somatic
 referred somatic
 radicular
 referred visceral
 referred trigger point pain
2. Assessment of Musculoskeletal Conditions

Demonstrate an understanding of other medical, physical Adopt a holistic approach viewing symptoms within the
and psychosocial factors that affect the specific context of the patient’s general characteristics, risk
musculoskeletal problem factors and social milieu
Demonstrate the ability to undertake a standard Take an accurate and relevant musculoskeletal history
musculoskeletal assessment relevant to the patient and including:
his/her presentation  a general history
 history of the presenting complaint including:
 mode and context of onset
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 detailed characteristics of the pain

 effects on the patient's life and work
Understand and work with the ‘look, feel, move, test

function, measure, look elsewhere, and image’ algorithm
Perform an appropriate musculoskeletal examination,

expanded where indicated into examination of other
systems:
 inspection including:
 surface appearance
 symmetry
 alignment
 spine
 gait
 assessment of movement including:
 active
 passive
 accessory
 relative smoothness
 end point quality
 appropriate provocation tests
 palpation of bones, muscles, tendons, entheses,
joint lines, and surface temperature
 assessment of sensation
Safely exclude other serious “red flag” conditions

requiring attention
Institute appropriate investigations to exclude significant

differential conditions and to elucidate the present
complaint
Demonstrate familiarity with the indications and

Demonstrate an understanding of the uses and limitations of investigational modalities, including:
limitations of imaging techniques  x-ray
 CT
 bone scan
 ultrasound
 MRI
Demonstrate skills in reading and interpreting results

from such investigations
Ability to consider the following:

 referred visceral and somatic pain both serious and
Demonstrate awareness of the presentation of spinal benign
and other musculoskeletal conditions as medical  spinal referred pain
‘masquerades’ and ancillary aspects of other medical  neoplasia, including myeloma, and cancer of lung,
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conditions breast and prostate

 inflammatory conditions including:
 gout
 pseudogout
 osteoarthritis
 rheumatoid arthritis
 psoriatic arthritis
 SLE
 polymyalgia rheumatica
 ankylosing spondylitis
 Reiter’s disease
 inflammatory bowel (disease related)
 fibromyalgia syndrome
 Infections including TB, other bacterial, herpes
zoster, discitis, osteomyelitis
 osteoporosis and spinal wedging
 vascular claudication
 reflex sympathetic dystrophy
 Paget’s disease
 migrainous phenomena
 neurological conditions
 depression induced spinal pain
 anticoagulant intraspinal haemorrhage
Evaluate the characteristics and profile of presenting

pain
Demonstrate an understanding of a pain profile
Accurately reproduce pain specifically related to the
presenting complaint
3. Treatment of Musculoskeletal Conditions

Institute a therapeutic process designed to produce, with Formulate a comprehensive treatment plan designed to
minimum delay, optimum function of the affected part or restore the patient as far as possible to optimum
parts functionality
Demonstrate a broad grasp of the current evidence- Understand and have basic skills in the common
based mainstream and alternative physical therapy treatments for musculoskeletal disorders with a focus on
treatments in Australia local needs including:
 patient directed techniques:
 specific exercises and stretches, post isometric
exercises, allied to breathing techniques
 correct sitting, lying and ambulatory posture
 application of ice, heat and warmth
 general aerobic and non-aerobic exercise
 relaxation and meditation techniques
 relevant lifestyle interventions including weight
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loss, stress reduction, recreational substance

reduction and sleep improvement
 therapist conducted techniques including:
 deep massage
 superficial massage
 traction
 joint mobilisation
 joint manipulation
 ultrasound, interferential, shortwave
 TENS
 analgesics
 NSAIDS
 trigger point injection
 steroid injections: depot, intra-articular, epidural
 dry needling and any other evidence based
acupuncture techniques
 the role of surgery
Understand the importance of a comprehensive

approach to recovery including:
 specific therapy
 psychological support
 self directed activities
 motivation
 a supportive environment
 general health initiatives
Understand the value of improving joint mobility by

various techniques of self-directed and therapist
movement and muscle stretching
Understand (“yellow flag”) factors relating to the

therapist, the patient and his or her environment liable to
impede recovery
Know the relative efficacy, uses, side effects and

potential abuses of pharmaceutical agents commonly
used in musculoskeletal conditions
Discuss, understand and compare several of the major

systems of musculoskeletal therapy
Understand and appreciate the broad history and

philosophy behind some of the major systems of
musculoskeletal therapy such as:
 chiropractic, osteopathy
 McKenzie, Cyriax, Maigne, Dvorak, Maitland
Methods
 Trigger point therapy
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Know how to get the family involved as a useful resource

in recovery, especially in matters of psychological
support
4. Coordination of Care

Demonstrate a commitment to co-ordination of care Recognise when other providers need to be involved
including:
 referral to other health providers when not able to Act as a case manager and exercise a role in:
provide total care  monitoring recovery
 ongoing monitoring  institution of appropriate intermediate activities in the
 shared care return to full function
 further strategic interventions where necessary  provision of different modalities of care as indicated
Assess the availability and capabilities of local

mainstream and alternative practitioners and more
distantly located specialists
Present a clear understanding of the issues involved in Recognise the importance of a multidisciplinary
work related injury approach to facilitate return to work
Recognise the many ‘yellow flag’ factors impeding this

process
Liaise with employers, work insurance officials,

rehabilitation agencies and where necessary with
lawyers, in facilitating return to work
5. Specific Musculoskeletal Conditions
5.1 Cervical Spine Conditions

Demonstrate competence in the diagnosis, treatment Understand the differential diagnosis of pain in the neck
and management of cervical spine conditions including:
 cervical spinal and non-spinal including psychogenic
Note:  thoracic and cranial referred
Most episodes of neck pain last no more than 10 days  inflammatory, infectious and neoplastic conditions
and up to 70% resolve within one month.
Understand the different sites to which cervical pain can
Self-management strategies should take precedence be referred
over therapist techniques, which may induce passivity in
the patient and ultimately impair recovery. Conduct a proper examination of the cervical spine,
including:
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Non-painful self or therapist effected repetition of cervical  musculature

movement tends to beneficially increase mobility. Non-  measured ROM
painful movement into, rather than away from stiffness or  joint palpation
resistance at the site of pain is more likely to promote  glide
recovery.  foraminal compression test
 brachial plexus tension and appropriate neurology
The distribution of pain may alter after such movement is
carried out. Reduction of referred pain, especially in a Outline the essential features of, cause of, and specific
central direction, tends to signal positive response. treatment for the following neck conditions including:
 vertebral stiffening – age, ankylosis
Immobilisation of the cervical spine tends to produce  spondylitis
chronic stiffness and pain.  postural syndromes
 facet joint dysfunction
 disc prolapse, disruption
 foraminal obstruction, radiculopathy, myelopathy
 torticollis (wry neck)
 trauma, sprain, ‘whiplash’, (fractures)
 psychogenic pain and depression
 neck pain in children
 inflammatory conditions, especially rheumatoid
arthritis, and red flag conditions especially neoplasia
and infections (section 2 above)
Know the patterns of pain referred to the head and face

from the neck
Distinguish cervical headaches from other causes of

headache
Perform the following skills (awareness of the dangers of

manipulation is paramount):
 teach:
 exercises
 control of posture
 use of pillows
 avoidance of harmful movement
 stretches, muscle energy techniques
 management planning for whiplash
 judicious mobilisation where self management is not
successful
 Z joint steroid injection
 dry needling
 ultrasound, TENS usage
Note: Manipulation has dangers and requires further

training
5.2 Cervical Syndromes
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Demonstrate competence in the diagnosis and Understand the importance of the following factors in
management of cervical syndromes cervicogenic headache:
 hydration
 substance and analgesic usage
 stress and sleep deprivation
Present an appropriate algorithm for treatment and

prevention of cervicogenic headache which includes self
care assisted by physiotherapeutic and musculoskeletal
techniques
Distinguish cervicogenic dizziness from other causes of

dizziness
Institute self-directed and assisted cervical mobilisation

where appropriate
Diagnose basilar /cervical artery syndrome, by history,

examination and provocation test
Be aware of the pitfalls of inappropriate manipulation in:

 basilar /cervical artery syndrome
 cervical myelopathy
5.3 Jaw Conditions

Demonstrate competence in the diagnosis and Conduct a proper examination of the temporomandibular
management of jaw conditions joint (TMJ)
Understand the causes and treatment of TMJ pain

including:
 dental malocclusion
 stress-related tooth grinding
 referred cervical (e.g. whiplash)
Outline the essential features of, cause of, and treatment

for:
 TMJ syndrome
 locked jaw
 sprains, arthritic conditions
Perform the following skills:

 corticosteroid injection
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 unlock jaw
 teach TMJ exercises
5.4 Shoulder Conditions

Demonstrate competence in the diagnosis and Understand the differential diagnosis of:
management of shoulder conditions  shoulder girdle, shoulder tip and upper arm pain,
including both systemic conditions
 conditions local to the arm, shoulder thorax, neck,
shoulder girdle
Conduct an appropriate examination including:

 a screen of the cervical spine
 appropriate resisted movements
 apprehension
 specific impingement tests
Outline the essential features of, causes of, and specific

treatments for the following conditions:
 capsulitis/frozen shoulder
 subdeltoid bursitis/supraspinatus tendinitis
 infraspinatus and other shoulder muscle conditions
 rotator cuff syndromes
 bicipital tendinitis
 acromioclavicular conditions
 sternoclavicular arthritis
 psychogenic shoulder/arm syndromes
 inflammatory conditions including rheumatoid
arthritis, osteoarthritis and polymyalgia rheumatica
 traumatic arthritis
 sports related problems

 management of acute soft tissue trauma
 steroid injection of biceps tendon, supraspinatus
tendon, glenohumeral joint and subacromial space
 basic stretches
 order, evaluate hydrodilatation
5.5 Elbow Conditions and Pain in the Arm

Demonstrate competence in the diagnosis, treatment Understand the differential diagnosis of:
and management of elbow and arm conditions  pain in the arm including both systemic conditions
 pain referred from the elbow, thorax, cervical spine,
shoulder and carpal tunnel
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Conduct an appropriate examination of the elbow and

arm

 lateral elbow pain
 medial elbow pain
 toddler's pulled elbow
 biceps lesions
 olecranon bursitis
 entrapment neuropathies
 arthritic conditions
 loose bodies
 overuse syndromes, industrial, psychosomatic and
otherwise
 thoracic outlet syndromes

 aspiration of olecranon bursa
 injection of medial and lateral epicondylitis,
olecranon bursa, and bicipital groove
 basic stretches
 delineate and advise concerning sports and work
related aspects
 appropriate surgical referral
5.6 Wrist and Hand Conditions

Demonstrate competence in the diagnosis, treatment Understand the sources of pain emanating from and
and management of wrist and hand conditions referred to the wrist and hand
Conduct an appropriate examination of the wrist and

hand
Assess wrist and hand pain, weakness and

paraesthesia; elicit Tinel’s and Phalen’s sign
Assess weakness

 carpal tunnel syndrome
 de-Quervain's tenosynovitis
 sundry other rare tendinitis
 sundry sprains
 trigger finger and thumb
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 spindle finger
 trigger finger
 scaphoid fracture
 ganglion
 lunate avascular necrosis, dislocation
 occult foreign body
 arthropathies
 Raynaud’s phenomenon and other neurovascular
disorders
 sympathetic, including psychosomatic, dystrophy

 application of fibreglass and plaster cast
 injection of corticosteroid for carpal tunnel,
tenosynovitis, other tendinitis, ganglion
 reduction of simple dislocation of thumb and finger
5.7 Thoracic Spine Conditions

Demonstrate competence in the diagnosis, treatment Understand the differential diagnosis and patterns of
and management of thoracic spine conditions pain in, referred within and from the thorax, and the
cervical spine
Note: Self-management strategies should take
precedence over therapist techniques, which may induce Provide an algorithm for the differentiation of visceral and
passivity in the patient and ultimately impair recovery somatic pain in the thorax and pain referred to the
abdomen, especially for red flag conditions, such as:
 cardiac ischaemia
 aortic dissection
 pneumothorax
 pulmonary neoplasm
 spinal infections and neoplasia
 confusing painful conditions such as herpes zoster,
oesophagitis, peptic ulcer, cholelithiasis and
psychogenic pain
Conduct an appropriate examination of the thorax and

thoracic spine together with relevant adjacent areas

 postural syndromes including minor kyphoscoliosis
and TV backache
 simple thoracic spine dysfunction, sprain
syndromes/‘derangements’
 costovertebral and facet joint syndromes
 T4 syndrome
 combined thoracic and cervical dysfunction
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 thoracic myofascial syndrome

 Tietze’s costochondritis
 kyphoscoliosis
 Scheurmann’s disorder
 age changes, osteoporosis, vertebral compression

 techniques for self correction of posture
 specific exercises
 p/a mobilisation and manipulation
 rotational manipulation optional
 corticosteroid injection around costovertebral and
facet joints
 injection and dry needling of trigger points
 Injection of fracture sites
5.8 ‘Low Back’: Lumbar Spine, and Sacroiliac Joint Conditions

Demonstrate competence in the diagnosis, treatment Understand the differential diagnosis and patterns of:
and management of low back, lumbar spine and  somatic pain in and referred from the low back and
sacroiliac joint conditions lumbar spine
 visceral sources of pain
Note: Most episodes of back pain last no more than 10
days and up to 90% resolve within one month. Understand the sources of pain derived from lumbar
structures, their relative frequencies, and current theories
Self-management strategies should take precedence of causation
over therapist techniques, which may induce passivity in
the patient and ultimately impair recovery. Distinguish between lumbar radicular and referred pain,
developing an algorithm for diagnosis of the underlying
Non-painful self or therapist effected repetition of lumbar condition, remembering conditions listed in section 2
movement tends to beneficially increase mobility. Non-
painful movement into, rather than away from stiffness or Be aware of the natural tendency for resolution of low
resistance at the site of pain is more likely to promote back pain in 4-6 weeks, and the undesirability of all but
recovery. very short term bedrest and inactivity
The distribution of pain may alter after such movement is Conduct an appropriate examination, including:
carried out. Reduction of referred pain, especially in a  palpation
central direction, tends to signal positive response.  mobility
 pain provocation
 weight bearing and gait of the lumbar spine and
region including the sacroiliac joints
 where applicable neurological examination of the
lower limbs
Conduct appropriate tests including blood and urine
Understand the practical role and function of available
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imaging techniques in the management of these

conditions
Be aware of the lack of evidence to link many imaged

lesions with production of pain

 mechanical back pain including
facet/zygoapophyseal and disc joint dysfunction
 posture syndromes
 dysfunction syndromes variously termed sprains and
‘derangements’
 minor and major trauma to muscle/bone
 spondylosis (degenerative osteoarthritis)
 symptomatic spondylolysis and spondylolisthesis
 acute and chronic intervertebral disc prolapse and
other discogenic pain
 nerve root compression and adherence
 spinal stenosis
 acute cauda equina syndrome
 stress, psychogenic, depression related and
behavioural syndromes
 sacroiliac joint related pain, sacroiliitis mechanical
hypermobile and hypomobile sacroiliac syndromes
 ‘Red flag’ conditions listed in Section 2 including
infection, UTI, malignancy and aortic aneurysm

 teach techniques in:
 improving their posture in sitting, standing and
lying
 use of appropriate lumbar supports for sitting
 improving lying posture
 provide instruction on exercises and stretches
 provide instruction on when to avoid certain
exercises and stretches
 provide instruction on relevant pharmacotherapy
 caudal epidural injection
 appropriate use of mobilisation and safe
manipulation.(only when self management
strategies have been exhausted) Optional
acquisition of these skills
 SIJ mobilisation and manipulation
 Use of sacroiliac belt
 lifestyle, work advice
 comprehensive treatment plans
 assistance with long term preventative strategies
 appropriate referral (urgent in cauda equina)
 Waddell's tests where appropriate
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5.9 Buttock, Hip, Pelvis and Thigh Conditions

Demonstrate competence in the diagnosis, treatment Understand the sources of pain referred to and
and management of buttock, hip, pelvis and thigh emanating from this region, particularly from the spine
conditions and the sacroiliac joint, and the downward referral of hip
pain to the leg
Know the age and sex related conditions of this region
Conduct an examination appropriate to the presenting

complaint

 psoas bursitis
 trochanteric bursitis
 hip arthritis, capsulitis
 loose bodies in the hip
 muscle strain, irritability, referred spasm, tendinitis
including psoas, glutei, piriformis, adductors, (rider's
sprain), quadriceps, hamstrings
 coxsalgia, coccydynia
 referred lumbar and sacral syndromes
 nerve entrapment/meralgia, hip pocket sciatic
compression, lateral cutaneous
 injuries, fracture
 snapping hip
 psychogenic conditions
 childhood conditions:
 congenital dislocation of hip
 synovitis
 Perthes Disease
 slipped upper femoral epiphysis
 stress fracture
 iliac traction apophysitis
 sundry conditions (see section 2):
 vascular claudication in elderly
 gynaecological conditions
 pregnancy related pain

 trochanteric and other corticosteroid injection
 teach appropriate stretches
5.10 Knee Conditions
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and management of knee conditions referred to the knee
Conduct an appropriate examination of the knee

including checks for effusion, inner abnormality and
ligamentous instability
Outline the process of early management of acute

trauma to the knee
Recognise and manage overuse syndromes
Outline the functional anatomy of the patellofemoral

system
Give the broad age distribution of knee conditions

 minor trauma, strain, sprain, synovitis
 cartilage, ligamentous injury (ACL, PCL, medial
collateral)
 effusion, haemarthrosis
 fracture
 loose bodies
 Baker's Cyst (simple and leaking)
 osteochondritis dissecans
 bursitis – sundry
 tendinitis – sundry
 locking and pseudolocking
 chondromalacia patella (jogger’s knee)
 patella subluxation and dislocation
 patellar tendinitis (jumper’s knee)
 Osgood-Schlatter's traction epiphysitis
 osteoarthritis
 other conditions listed in section 2

 appropriate joint bursa aspiration
 appropriate joint corticosteroid injection
 extra-articular corticosteroid injection
 unlock locked knee
 appropriate use of orthotic devices
 teach exercises, stretches, ambulatory posture,
lifestyle measures including appropriate exercise
and weight reduction
 appropriate timely surgical referral
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5.11 Lower Leg, Ankle and Foot Conditions

and management of lower leg, ankle and foot conditions referred to the lower leg, ankle and foot
Note: The application of imaging modalities including Conduct an appropriate examination of the lower leg,
nuclear scan and ultrasound to foot and ankle conditions. ankle and foot
Demonstrate awareness of the importance of foot

problems in determining mobility and general fitness
especially in the elderly
Understand the general principles of podiatry and the

correct application of orthotic devices to restore effective
ambulation and relieve pain

 achilles tendinitis, bursitis, partial and complete
rupture
 peroneal muscle strain
 tibialis posterior tendinitis
 Periostitis (shin splints)
 compartment syndrome
 common peroneal entrapment
 other conditions listed in section 2
 childhood conditions including:
 gait problems
 calf tightness
 Sever’s traction apophysitis
 ankle sprains and associated minor fractures
 deltoid ligament sprain
 loose body in ankle
 plantar fasciitis
 mid-tarsal sprain
 metatarsalgia
 stress fracture
 tarsal tunnel syndrome
 disparate leg length
 conditions listed in section 2, including:
 early RA
 gout
 RSD
 complications of diabetes
 childhood conditions including:
 injury
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 sprain
 bone and chondral fracture
 Kohler’s and Freiberg’s Diseases
 sundry conditions including:
 corns
 calluses
 ingrowing toenail
 bunion
 hallux rigidus and other osteoarthritides
 Morton’s neuroma
 fractured 5th toe
 claw toe
 hammer toe
 postural problems including inversion, eversion
and bumbling

 recognise need for orthotics
 appropriate corticosteroid injection, sundry sites
 treatment of plantar wart
 treatment of ingrowing toenail
 Mobilisation of stiff joints
 Immobilisation of fractured 5th toe

Appraise own clinical performance Critically reflect on consultations to identify strengths and
staff
Demonstrate an ability to recognise one’s own limitations Demonstrate an awareness of local issues which impact
and appropriately determine when to refer on the decision to treat or refer, such as local transport
and evacuation processes
Demonstrate an awareness of the differing resources in Understand and utilise the extended role of other health
rural/remote communities and ability to improvise when care practitioners and services in the local area
necessary
Appreciate the cost effectiveness of differing strategies in
the management of musculoskeletal conditions
network
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6.10.6 Teaching and Learning Methods

Consideration will be given to an introductory exercise early on in the general practice segment of training. The earlier
the better to encourage registrars to be aware of the substantial musculoskeletal case load that is likely to be passing
before them. Material that summarises the case mix of musculoskeletal conditions presenting in rural and remote
general practice, with a brief introduction to basic science and diagnosis is desirable. This requires a reorientation of
musculoskeletal teaching in terms of understanding and management. It is also appreciated that there are differences
of opinion between schools and individuals in Australia but it is hoped that this curriculum statement offers a pointer
towards uniformity of approach to FACRRM registrar training.
Assessment
Emphasis should be on diagnostic skills and recognition of optimum treatment algorithms with encouragement of
hands on skills rather than compulsory acquisition of set skills.
6.10.7 Resources/Readings
Core reading:
Murtagh. J. General Practice. McGraw Hill. Chapters 10, 19, 31, 32, 34, 52-57 (current edition).
Murtagh J, McKenna C. Back pain and spinal manipulation, Butterworths (current edition).
Hertling and Kessler: Management of Common Musculoskeletal Disorders. Lippincott (3rdedition).
Useful texts and resources:
Australian Musculoskeletal Medicine: Journal of the Australian and New Zealand Association.
Broadhurst, N Musculoskeletal examination (Videotapes) Flinders Media Centre, Bedford Park, SA, 5042, tel 08 8204
4988 to be used concurrently with the Flinders Manual of Musculo-skeletal medicine.
Corrigan B and Maitland G D. Practical Orthopaedic Medicine – Vols I and II Vertebral and Appendicular Butterworths
(current edition).
Cyriax J (1982) Textbook of Orthopaedic Medicine Vol 1, 8thEdition Bailliere Tyndall.
Cyriax J, Cyriax P (1993) Cyriax's illustrated manual of orthopaedic medicine. Butterworths Heinemann Oxford
(3rdedition).
Maitland GD (1986) Vertebral manipulation 5thEdition Butterworths London.
McKenzie R (1989) The Lumbar Spine Mechanical Diagnosis and Therapy. Waikanae, New Zealand: Spinal
Publications.
McKenzie R (1990) The Cervical and Thoracic Spine Diagnosis and Therapy. Waikanae, New Zealand: Spinal
Publications.
McKenzie R (1997) Treat Your Own Back 7thEdition. New Zealand. Spinal Publications.
McKenzie R (1980) Treat Your Own Neck. New Zealand. Spinal Publications.
Newcastle University Bone and Joint Institute videotapes on basic musculoskeletal science, pain and biomechanics.
Further texts can be expected.
Ombregt L, Bisschop P, ter Veer HJ, Van de Velde T (1997). A System of Orthopaedic Medicine WB Saunders:
London.
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Working Party
Dr Mike Taylor
Dr Mike Moynihan
Assoc. Professor Norm Broadhurst
Professor John Murtagh
Dr Mark Craig
Dr Bruce Chater

Dr Peter Baker
Dr Steve Howle
Dr Steve Jensen
Dr Michael Yelland
Dr Rob Gassin
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6.11 OBSTETRICS/WOMEN’S HEALTH
6.11.1 Context
Medical school term in obstetrics and gynaecology

3 months postgraduate training in obstetrics

Emergency medicine, paediatrics, anaesthetics, adult internal medicine

The registrar will:
 demonstrate the appropriate knowledge, practical skills and attitudes to provide antenatal care and postnatal
care in conjunction with a generalist obstetrician, specialist or retrieval program (as appropriate) in rural/remote
practice
 demonstrate the appropriate knowledge and practical skills to manage normal labour and delivery in consultation
with a generalist obstetrician, specialist or retrieval program (as appropriate) in rural/remote practice
Note: For registrars to satisfactorily complete the learning required for this curriculum statement, they need to
perform a minimum of 20 normal deliveries throughout their training. However, it is not the intention of ACRRM to
qualify registrars to routinely perform deliveries. If doctors wish to do this, they will need to undertake further training.
 demonstrate the knowledge, practical skills and attitudes to provide women’s health care in rural/remote practice
 understand the importance of appropriate decision making about local management, consultation and referral for
obstetric, gynaecological and other women’s health conditions, and
activities in the provision of obstetric and women’s health services in rural/remote practice.
1. Background Knowledge 4. Women’s Health Issues

2. Pregnancy 4.1 Gynaecological Skills
2.1 Pre-Pregnancy 4.2 Contraception
2.2 Unplanned Pregnancy 4.3 Sexually Transmitted Infections
2.3 Antenatal Care 4.4 Menopause
2.4 Postnatal Care 4.5 Infertility
3. Obstetric Skills 4.6 Sexuality
6.11.4 Content
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Demonstrate knowledge of relevant anatomy,
physiology, pathology and current research findings in
the management of common obstetric and
gynaecological conditions
Outline legal responsibilities regarding notification of

disease, birth, death and autopsy etc relevant to the
state concerned
Demonstrate an understanding of the social, cultural and

environmental influences on obstetric and Describe the social, cultural and environmental factors
gynaecological service needs of rural/remote which have an impact on:
communities  risk factors
 health patterns
2. Pregnancy
2.1 Pre-Pregnancy

Conduct a thorough pre-pregnancy consultation Undertake a pre-pregnancy assessment of health
including:
 rubella immunisation
 Pap smear
 blood group and Rh antibodies
Provide lifestyle counselling including:

 alcohol use
 drug use
 smoking
 nutrition
 exercise
 taking folate supplements
 avoiding listeria prone foods
 reducing risk of toxoplasma and CMV infection
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Identify those who should be offered genetic counselling
2.2 Unplanned Pregnancy

Provide advice and counselling to patients presenting Counsel patients regarding options or alternatively
with an unplanned pregnancy provide information on community services available to
patients to discuss options
Be aware of available community counselling and

support services and means of access
Be aware of relevant state legislation and the cost,

availability and accessibility of local services for
termination of pregnancy
2.3 Antenatal Care

Perform an initial antenatal assessment identifying the Conduct pregnancy testing
potential risk factors for mother and foetus during
pregnancy Elicit an accurate and detailed obstetric history
Perform an antenatal examination, demonstrating an

ability to identify women at high risk of complications
Identify and describe antenatal problems of specific

groups at risk:
 aboriginal women
 migrant women
 women with a drug addiction
 older women
Describe first trimester problems and approaches to

managing them:
 early bleeding
 miscarriage
 ectopic pregnancy
Undertake antenatal testing Order and interpret routine screening tests and other
investigations as necessary including:
 ultrasound
 amniocentesis
 chorion
 villus biopsy
Recognise the signs and symptoms of patients that are
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Determine a management plan tailored to the specific beyond one’s ability to manage and require referral to
needs of individual patients specialised antenatal care

patients who require specialised antenatal care
Outline the management principles of antepartum

haemorrhage including role of Anti-D
Outline management principles of common

complications e.g. Diabetes, PET
Provide advice on the treatment of minor antenatal

problems such as:
Provide counselling and advice on the management of  nausea
pregnancy and birth  vomiting
 urinary frequency
 cramps
 syncope
 back pain
 intercurrent infections (respiratory, urinary and
vaginal)
Provide lifestyle counselling on:

 drug use, including alcohol and smoking
 nutrition
 exercise
Assess the emotional and social needs of the patient and

the family and provide counselling or refer as appropriate
 changes in emotional and sexual dynamics during
and after pregnancy
 impact of new baby on family members
Describe childbirth options and principles of childbirth

education
Know of available community facilities/resources and

means of access including:
 local antenatal classes
 breastfeeding support services
 midwife services
2.4 Postnatal Care

Perform a postnatal assessment, identifying the ongoing Post-operatively manage common obstetric conditions
care requirements
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Perform a neonatal examination
Be skilled in the ongoing care of common neonatal

problems
Perform neonatal resuscitation

beyond one’s ability to manage and require referral to
specialised postnatal care

patients who require specialised postnatal care
Advise on contraception
Provide counselling and advice on the physical and
emotional issues experienced by women in the first 12 Provide advice and support regarding breastfeeding
months following childbirth problems:
 inverted nipples
 cracked nipples
 mastitis
 breast engorgement
 drug contraindications
Provide advice and treatment as appropriate for:

 pelvic infections
 pelvic floor muscles
 breast infections
 UTI
 perineal wound infection
 sexual problems
 stress
 social role demands
Be alert for postnatal depression, manage and refer if

indicated
Provide initial counselling for families experiencing:

 prenatal death
 child born with abnormalities
3. Obstetric Skills

Demonstrate the clinical skills required to competently Outline the principles of and indications for emergencies
manage emergency labour and delivery arising during labour and delivery
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Outline a plan for the management of emergency labour

and delivery
Manage normal labour and delivery under emergency

circumstances in consultation with a GP Obstetrician,
specialist or retrieval program as appropriate
Recognise the signs and symptoms of abnormal labour –

e.g. incoordinate labour, abnormal bleeding, high blood
pressure – that require referral to specialised care

patients who require specialised care
Describe the management of postpartum and secondary

postpartum haemorrhage and endometritis
Outline the management of labour and delivery

complications:
 bleeding
 perineal pain
 fever
Perform episiotomy
Competently perform a range of common obstetric
procedures Repair small tears (2nd degree)
Outline the principles of repairing 3rd degree tears
Repair episiotomy (extended)
Outline the indications for performing urethral

catheterisation
Perform urethral catheterisation
Use a partogram
Describe the management of spontaneous abortion
4 Women’s Health Issues
4.1 Gynaecological Skills

Demonstrate competence in recognition of signs and Diagnose and manage the following common
symptoms requiring further investigation, and in methods gynaecological conditions:
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of management  symptoms suggestive of cancer

 endometriosis
Demonstrate competence in the post-operative  pelvic pain
management of common gynaecological conditions  pelvic inflammatory disease
 vaginitus
 genital warts
 asymptomatic cervical HPV infection
 Bartholin’s cysts/abscess
 ovarian cysts
 uterine fibroids
 polyps
 prolapse
 candida
Diagnose and manage the following common menstrual

problems:
 pre-menstrual syndrome
 amenorrhoea
 non-cyclical bleeding
 menorrhagia
 dysmenorrhoea
Identify indications for hysterectomy/endometrial ablation

and provide appropriate counselling
Identify indications for urinary tract infections and

urethral syndrome and outline appropriate management
Outline the principles of the prevention and management

of incontinence
Identify indications for diseases of the breast and outline

appropriate management
Demonstrate the ability to recognise the signs and

symptoms of patients that are beyond one’s ability to
manage and require referral to specialised
gynaecological care
Competently conduct a pelvic examination

Demonstrate competence in performing a range of
common gynaecological procedures Competently fit a diaphragm
Competently perform a cervical smear
4.2 Contraception

Demonstrate an understanding of the range of Outline the efficacy, effectiveness, various types, use of,
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contraception options and the relative advantages and contraindications and management of side effects for the
disadvantages of each option range of contraception options including:
 oral contraceptives
 medroxyprogesterone acetate
 mechanical methods (condoms, diaphragms)
 ovulation prediction methods (natural family
planning)
 emergency contraception (post coital)
 surgical contraception
Educate patients about choice and use of contraceptive

methods and negotiating safe sex
4.3 Sexually Transmitted Infections

Demonstrate competence in the prevention, diagnosis Educate patients about preventing STIs and negotiating
and management of sexually transmitted diseases safe sex:
 use of condoms
Outline the diagnosis, testing and referral procedures for

common STIs
Perform basic gynaecological procedures for the

diagnosis of STIs:
 demonstrate competence in specimen collection for
screening test/s
 demonstrate competence in conducting an
examination for STIs including a pelvic examination
Outline current effective treatments for and management

of common STIs
Outline the principles of contact tracing and the

management of partners with STIs
Outline the legal requirements of general practitioners in

relation to STIs
Outline HIV antibody testing and protocols
Understand the emotional and support needs of patients

with STIs
4.4 Menopause
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Recognise and provide advice and treatment to patients Provide information and counselling on menopause in
experiencing menopause relation to:
 the immediate symptoms of the menopause
 long term consequences of the menopause
 management options
 risks and benefits of the use of hormone
replacement therapy
 HRT types, different regimens and appropriate
investigation
 HRT to prevent osteoporosis and
cardiovascular disease
 alternative options to HRT
4.5 Infertility

Demonstrate an understanding of the physical and Outline the causes of infertility
emotional issues associated with infertility and be able to
outline current treatment options Identify infertility prevention strategies
Identify appropriate investigations and referral

mechanisms
Describe treatment options for infertile couples
Understand the emotional and support needs of infertile

couples
4.6 Sexuality

Demonstrate an appreciation of the human sexual Counsel patients regarding sexual preferences and
response, sexuality and the spectrum of sexual sexual dysfunction
behaviours
Be aware of community resources and agencies for
referral as appropriate

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staff
Demonstrate an ability to recognise one’s own limitations Be aware of local issues which impact on the decision to
and appropriately determine when to refer treat or refer, such as local transport and evacuation
processes
Demonstrate an awareness of the differing women’s Understand and utilise the extended role of other health
health and obstetric resources in rural/remote care practitioners and services in the local area
communities and ability to improvise when necessary
Developed strategies for self care and self reliance Develop a peer, professional and personal support
network
Working Party
Dr Tom Doolan
Dr Les Woollard
Dr Tony McLellan
Dr John Evans

Dr Bruce Chater
Dr Nick Silberstein
Dr Mike Moynihan
Dr Christina Port
Dr Nicholas Williams
Dr Don Gunning
Dr Chris Hegerty
Dr Daniel Manahan
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6.12 OFFICE BASED GENERAL PRACTICE
6.12.1 Context
Medical school studies and terms in rural and remote general practice

Rural hospital and general practice posts

Population health, Aboriginal and Torres Strait Islander health, adult internal medicine, child and adolescent health
6.12.2 Background
General practice in the rural/remote context provides doctors with the opportunity to practice true continuing,
comprehensive, whole patient care from infancy to elderly within a defined community setting. It involves the total bio-
psychosocial management of the health problems of the individual, family and community with implicit life-saving
responsibility in emergencies as the bottom line. Rural and remote practitioners operate within an environment of
greater diagnostic uncertainty than their urban counterparts. This is largely due to a limited access to diagnostic
facilities. To this end, this type of practice arguably represents general practice in its purest form.

The registrar will:
 demonstrate a thorough grounding in the theory and practice of providing primary, continuing, comprehensive,
community based, prevention-oriented care in rural and remote communities
 demonstrate an appreciation of the unique qualities and skills required of general practitioners to provide holistic
care in rural and remote communities
 understand the significance of the doctor–patient relationship in determining an effective diagnosis and
management plan
 demonstrate the ability to work as part of a multi-disciplinary team in providing coordinated, continuing care to
patients in rural and remote communities, and
 demonstrate self-caring capabilities.
1. Doctor – Patient Relationship in the Rural/Remote 5. Illness Prevention and Health Promotion
Community Context
2. Continuing Comprehensive Care 6. Interprofessional Collaboration
3. Dealing with Uncertainty 7. Professional and Ethical Responsibilities
4. Resource Management
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6.12.5 Content
1. Doctor – Patient Relationship in the Rural/Remote Community Context

Develop a relationship with the patient which enables: Establish and maintain rapport with patients
 the development of an understanding of
illness/problems as experienced by the patient Be able to empathise with patients and make them
 determination of a mutual agreement for the comfortable to talk openly about their problems
management of the condition
Be aware of verbal and non verbal communication
techniques
Appreciate cultural differences and associated difficulties

in communication
Be skilled in active listening
Negotiate an effective management plan and agree on

respective responsibilities and limits with the patient and
their family
Educate patients to optimise self care and compliance
Effectively provide accurate and comprehensible

information about diagnosis and/or deterioration in a
sensitive manner to patients and carers
Undertake a flexible approach to consulting with people

Demonstrate an appreciation of local social and cultural from different cultural and social backgrounds
milieu
Utilise local resources to establish credibility and achieve
effective communication
2. Continuing Comprehensive Care

Manage undifferentiated problems in the context of a Possess a sound working knowledge of a wide range of
continuing personal relationship with patients and health and disease processes
families
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Possess sound clinical skills that enable a wide range of

problems to be managed
Apply a holistic approach to patient care, appreciating

that illness is related to the personal, family, social,
cultural and economic context of a patient’s life as well
as specific agents of disease
Seek to understand the context of illness experienced by

a patient
Competently manage common problems including

undifferentiated illness
Develop and maintain essential emergency

management, procedural and psychosocial skills
Demonstrate a commitment to the patient to provide

ongoing personalised care
Possess the knowledge and clinical skills to provide

comprehensive primary care as well as secondary and
tertiary care services as required
Recognise when a presenting problem is beyond one’s

own abilities and the management capabilities of local
resources and require referral to specialised care
Outline plan/protocol for referral and follow-up of patients

who require specialised care
3. Dealing with Uncertainty

Accept uncertainty and the need to evaluate the risks Elicit information on the bio-psychosocial context of a
versus the benefits of each clinical decision presenting problem and devise a management plan
which takes into consideration all of these aspects
Appreciate that it is not always possible to reach a

differential diagnosis for the presenting problem/s of a
patient. In these circumstances, be able to determine a
plan for reaching a diagnosis while still maintaining the
confidence of the patient
Minimise diagnostic and management errors through

identification of risks and early departures from normality
in patients
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beyond one’s ability to manage and require referral to
specialised care
4. Resource Management

Demonstrate competence in the deployment of Possess organisational and time management skills
resources in the practice, community and health care
system for the benefit of patients Understand the health care system i.e. funding, planning,
services, policies and community resources and their
role in it
Use hospital and community based expertise, resources

and networks effectively
5. Illness Prevention and Health Promotion

Work with individuals, the community and health Understand population health principles
professionals to prevent illness and optimise community
health status Be familiar with the principles of and demonstrate
competence in undertaking the following interventions:
Note: See also Population Health Curriculum Statement  health enhancement e.g. diet advice
 counselling and education e.g. smoking cessation
 screening and early detection e.g. systematic pap-
smear testing supported by recall systems
 monitoring of established disease e.g. blood
pressure
 immunisation and chemoprophylaxis
Educate and inform individuals and/or their families

about their health including:
 risk avoidance
 risk education
 early detection of disease
 quality use of medicines
 guidance towards additional resources in the
practice or community
Participate in community based prevention and

education activities
6. Interprofessional Collaboration
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Section Two

coordination of care Members and other health care providers to provide
optimal patient care including: appropriate referrals, case
conferencing, medication reviews, care plans etc


staff
Developed strategies for self care and self reliance Develop a peer, professional and personal support
network
Develop relaxation skills and non-medical interests
6.12.6 References
The content of this document is based on material sourced from the following:
Australian College of Rural and Remote Medicine. (1997). Prospectus. Australian College of Rural and Remote
Medicine, Brisbane.
McWhinney I R. (1989). A Textbook of Family Medicine. Oxford University Press, New York.
Strasser R. (1991) General practice – what is it? The Medical Journal of Australia. 155(8): 533-534.
Hays R. (1999). Practice Based Teaching. Eruditions Publishing, Melbourne, Australia.
Dr Pat Giddings
Prospectus Working Party:

Dr Lexia Bryant
Dr John Douyere
Dr Myrle Gray
Page 186 of 275

Section Two
Dr Chris Homan
Dr David Mildenhall
Dr Tim Mooney
Dr Wendy Page
Dr Jack Shepherd
Professor Roger Strasser

Dr Robert Hall
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Section Two
6.13 OPHTHALMOLOGY
6.13 OPHTHALMOLOGY
6.13.1 Context

Medical school studies in neuroanatomy, head and neck anatomy, neurophysiology, neuropathology and head and
neck pathology

Three month clinical attachment, hospital ophthalmology post, ophthalmology clinic, eye casualty

Surgery (ENT), general medicine (neurology)

The registrar will:
 demonstrate skills in taking a relevant history and performing a physical examination

 demonstrate the ability to recognise and treat emergent causes of visual loss
 understand the principles of the management of ocular emergencies, and
 demonstrate the ability to evaluate and manage ophthalmological disorders that commonly present in
rural/remote settings.
1. Background Knowledge 6. Blindness

2. Examination and Interpretation 7. Strabismus and Abnormal Eye Movements
3. Ocular Emergencies 8. Treatment
4. The Red Eye 9. Communication and Support
5. Abnormalities of the Optic Nerve and Fundus 10. Professional and Ethical Responsibilities
6.13.4 Content

Demonstrate a working knowledge of the normal Within the context of the role of the rural/remote general
anatomy, physiology and ocular function of the eye practitioner discuss the features of:
 the anatomy of the eye
 ophthalmic optics
 the physiology of vision
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6.13 OPHTHALMOLOGY
 the process of ageing of the eye
2. Examination and Interpretation

Demonstrate skills in undertaking relevant diagnostic Take a symptom history and perform an ocular
procedures and interpreting the results examination to help localise the problem, taking into
account the special needs of children, illiterate persons
etc
Understand normal neurological, motor responses and

appearance
Test and evaluate visual function within the context of

the role of the rural/remote general practitioner including:
 visual acuity
 colour vision
 visual fields
 ocular motility
Perform an examination of the external eye including the

conjunctivae sclera, cornea and eyelids and be able to
evert the upper lid
Perform examinations using an ophthalmoscope,

including fundoscopy
Measure intraocular pressure using both the Schiotz and

Applanation tonometry techniques and be familiar with
other techniques for measuring intraocular pressure such
as the Puff tonometer
Test pupillary function
Test and evaluate abnormal eye movements and

positions
Perform fluorescein staining of the cornea and sclera
Perform slit lamp examinations to:

 remove corneal foreign bodies
 diagnose iritis
 assess corneal ulcers
 assess eye trauma
Be familiar with using basic equipment for imaging of the

retina
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6.13 OPHTHALMOLOGY
3. Ocular Emergencies

Demonstrate competence in the diagnosis and Outline the essential features of, causes of, and, specific
management of ophthalmological emergencies with treatment and referral criteria for the following:
consultation and referral as appropriate  injuries to the eye:
 chemical
Note: See also Emergency Medicine Curriculum  blunt and penetrating trauma to eye and
Statement surrounding tissues
 subtarsal and corneal foreign bodies
 scratches and abrasions
 hyphaema
 blowout fracture
 UV trauma
 welders flashburns
 snow blindness
 acute loss of vision
 vascular occlusion
 giant cell arteritis
 retinal detachment
 proptosis
 acute chalazion
 glaucoma
Identify ocular conditions that raise suspicion of child

abuse
Outline the specific issues and steps involved in urgent

referral and transfer of patients with eye trauma e.g. air
transportation for penetrating eye injuries or blowout
fracture
4. The Red Eye

Demonstrate competence in the correct evaluation and Outline the essential features of, cause of,
management of conditions causing red eye, with specific treatment for and referral criteria for
consultation and referral as appropriate the following conditions:
 conjunctivitis
 viral
 herpetic eye disease
 herpes simplex
 herpes zoster
 bacterial
 allergic
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6.13 OPHTHALMOLOGY
 trachoma
 trichiasis
 conjunctival tumours
 corneal diseases
 keratitis
 corneal ulcers
 conjunctival nevus
 pterygium
 pinguecula
 foreign bodies
 uveitis
 drug allergy
 acute glaucoma
 episcleritis/scleritis
 neonatal sticky eyes
 dry eyes
 red lids
 blepharitis
 entropion
 ectropion
 stye
 chalazion
5. Abnormalities of the Optic Nerve and Fundus

Demonstrate competence in diagnosing and interpreting Dilate the pupils:
abnormalities of the optic nerve and fundus  drops to use/not to use
Be familiar with common disc and retina abnormalities

including:
 Optic disc abnormalities in glaucoma
 Optic disc swelling
 Optic atrophy
 Diabetic retinopathy
 Hypertensive retinopathy
 Age related maculopathy
6. Blindness

Recognise causes of preventable blindness and Explain the principles of management of the vision
minimise deterioration of function through appropriate impaired including:
initial treatment and referral  common causes of blindness
 screening and referral
 helping the blind
 low vision services available in Australia
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6.13 OPHTHALMOLOGY
Discuss the presenting signs, symptoms and

management of cataracts:
 epidemiology
 diagnosis
 effect on vision
 treatment options – surgery

management of glaucoma:
 anatomy, epidemiology
 diagnosis
 disc appearance
 visual field loss
 tonometry
 treatment options

management of diabetic retinopathy:
 epidemiology
 diagnosis
 effect on vision
 treatment options
7. Strabismus and Abnormal Eye Movements

Demonstrate competence in the recognition and Recognise normal eye movements
management of strabismus and abnormal eye
movements Explain the conditions of squint and double vision
Diagnose and provide initial treatment for common

childhood disorders:
 hypermetropia and convergent squint
 amblyopia
 divergent squint
 nasolacrimal obstruction
Know of the importance of early recognition and

treatment of amblyopia
Diagnose and provide initial treatment for:

 palsies
 thyroid eye disease
 other adult squints
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6.13 OPHTHALMOLOGY
8. Treatment

Demonstrate competence in providing appropriate Use topical and systemic medications for the treatment
treatment for common ocular conditions of the eye:
 identify the dosages, indications and
contraindications of topical and systemic
ophthalmological medications including:
 antibiotics
 antivirals
 topical steroids
 anti-glaucoma
 mydriatics and cycloplegics
 diagnostic agents
 local anaesthetics
 explain the ocular side effects of topical and
systemic drugs
 instil eye drops and ointment
 tape lids to prevent corneal and conjunctival
exposure
Perform the following therapeutic procedures:

 pressure patch an eye
 irrigate an eye
 remove contact lenses
 shield eye
 removal of corneal foreign bodies
 removal of subtarsal foreign bodies
 curettages of chalazion
 be familiar with the procedure of irrigation of the
blocked nasolacrimal duct
9. Communication and Support

Demonstrate an understanding of the communication Explain the psycho-social effects of loss of vision and the
skills and attitudes needed to foster wholistic care need for a compassionate and supportive approach to
care
Explain the role of support systems in the health of

patients with ocular disease
Explain the role of other health care professionals,

including ophthalmologists, optometrists, opticians in
diagnosing and treating conditions of the eye
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6.13 OPHTHALMOLOGY




processes
Demonstrate an ability to recognise one’s own limitations
network
Working Party
Dr Angus McClure
Dr Chris Hopwood
Dr Pat Giddings
Associate Professor Claire Jackson
Dr Tim Roberts

Dr Gary Bourke
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6.14 ORAL HEALTH
6.14 ORAL HEALTH
6.14.1 Context

Medical school studies in head and neck anatomy, physiology and pathology

One week clinical attachment in dental clinic or dental practice

Anaesthetics, emergency medicine, child and adolescent health, surgery

The registrar will:
 demonstrate the ability to distinguish between normal and abnormal conditions of mouth and jaw
 demonstrate the necessary knowledge and skills to manage dental pain in absence of a dentist
 demonstrate the necessary knowledge and skills to provide early management in relation to oro-facial trauma
that optimises dental outcomes for the patient
 demonstrate the capacity to work with others and to utilise the talents and skills of other health care
professionals in making specific management decisions, and
 demonstrate the ability to reflect on their care and management of patients with dental emergencies and to use
this to improve professional practice.
1. Background Knowledge 4. Children

2. Managing Trauma 5. Adults
3. Dental Blocks
6.14.4 Content

Demonstrate a basic working knowledge of dentistry Understand the main concepts and principles of:
 dental history taking
 extra- and intra-oral examination
 brief stages of dentition
 tooth structure
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6.14 ORAL HEALTH
 dental treatment procedures
2. Managing Trauma

Demonstrate competence in the management of Discuss the differential diagnosis and demonstrate
traumatic dental injuries correct evaluation and management of patients
presenting with:
 injuries to periodontal structures
 intrusion
 subluxation
 concussion
 intrusive luxation
 extrusive luxation
 lateral luxation
 avulsion
 trauma involving bone
 jaw dislocation
 jaw fracture
 enamel fracture
 pulpal exposure
 soft tissue injuries of the oral cavity
Perform a neurological assessment if head trauma is

sustained
Give prophylactic tetanus as warranted
Appropriately develop and utilise a referral and advisory

network
3. Dental Blocks

Understand the principles of administering dental blocks Identify indications for use of dental blocks
Note: See also Anaesthetics Curriculum Statement Be aware of the different types of dental blocks and their
effects
Understand the techniques involved in administering

dental blocks
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6.14 ORAL HEALTH
4. Children

Demonstrate competence in assisting children and their Discuss the diagnosis, evaluation and management of:
parents with specific oral problems  oral thrush
 teething
 nursing bottle caries
 juvenile periodontal disease
 ulcerations
 swellings
 wisdom teeth
 dental caries
 tooth abscess
 fluoridation
Provide parental instruction in oral hygiene techniques

for children to help prevent dental caries
Advise parents on remedies for excessive, prolonged

thumb/finger sucking
5. Adults

Demonstrate competence in assisting adult patients with Discuss the diagnosis, evaluation and management of
their specific oral problems patients presenting with:
 gingivitis/periodontal disease
 pregnancy related gingivitis
 ulcerations
 swellings
 salivary gland blockage
 dental caries
 dry socket
 pericoronitis
 tooth abscess
 sensitive teeth
 temporomandibular joint pain and bruxism
 denture hygiene
 candida and other infections
Prescribe appropriate oral pain relief and antibiotic

treatments as necessary
Identify potential oral complications associated with:

 diabetes
 cancer treatment
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6.14 ORAL HEALTH
 HIV/AIDS
Identify potential oral complications associated with

systemic medications such as:
 prolonged use of steroids
 anti-depressant medications
Working Party
Dr Cameron Scott (writer)
Dr Julie Savage
Dr Steve Lawley

Dr Daniel Manahan
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Section Two
6.15 PALLIATIVE CARE
6.15.1 Context
Postgraduate terms in Adult Internal Medicine and Surgery, medical school studies in Pharmacology

Rural/Remote hospital and general practice posts

Adult Internal Medicine, Surgery, Anaesthetics, Psychiatry, Principles of Rural and Remote General Practice

The registrar will:
 demonstrate the clinical and evaluation skills necessary to ensure the best quality of life for patient and family
 understand the principles of the palliative approach and experience in the physical, psychosocial, cultural,
practical, ethical and professional aspects of palliative care, and
 understand the importance of and need for teamwork and the role of other health professionals and individuals in
providing palliative care.
1. Principles of Palliative Medicine 5. Organisational Aspects of Care

2. Pain 6.1 Ethical Responsibilities
3. Symptom Control 6.2 Professional Considerations
4. Psychosocial and Spiritual Support
6.15.4 Content
1. Principles of Palliative Medicine

Demonstrate an understanding of the philosophy of Explain the aims of palliative medicine
palliative care and the role of the rural/remote doctor in
providing palliative care Acknowledge that a patient’s comfort and dignity is the
ultimate priority of care provision
Integrate a supportive component into all aspects of

providing palliative care
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Demonstrate an understanding of the disease process Know the natural history, markers of progression and
range of treatments available at each stage of:
 malignant diseases
 non-malignant conditions
Anticipate likely potential problems caused either by the

disease or by treatments
Be skilled in the diagnosis and management of common

recurrent conditions
2. Pain

Undertake a comprehensive pain assessment Understand the definitions, physiology and concept of
pain
Assess the pain experienced by a patient by gathering

information on the following:
 site of pain
 quality of pain
 exacerbating and relieving factors
 its temporal onset
 its exact onset
 the associated symptoms and signs
 interference with activities of daily living
 impact on psychological state
 response to previous and current analgesic
therapies
Be familiar with the use of pain charts to measure pain
Assess the type/s of pain experienced by a patient:

 nociceptive
 non nociceptive
 acute
 chronic
Understand the range of pharmacological treatment

Understand the various modes of pain treatment and options and their use including:
their appropriate applications  non opioid analgesics
 opiods
 adjuvants
 NSAIDS
 antidepressants
 local anaesthetic agents
 corticosteriods
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 antispasmodics
 anticonvulsants
 antiarrhythmics
 Anxiolytics
Demonstrate an awareness of the pharmacokinetic

considerations of drug treatment
Understand the range of non-pharmacological treatment

options and their use including:
 radiotherapy
 chemotherapy
 nerve blocking procedures
 epidural/spinal injections
 ventriculostomy
 other neurological techniques
 transcutaneous electrical nerve stimulators (TENS)
 physiotherapy
 occupational therapy
 complementary medicine/therapy
Understand emotional issues involved in pain

management
Set realistic pain management goals in consultation with

patient and family
3. Symptom Control

Demonstrate the ability to determine the cause of, and Understand relevant anatomy and physiology
manage gastrointestinal tract problems experienced by
patients including: Undertake appropriate assessment of symptoms
 oesphageal problems
 dyspepsia Undertake appropriate examination and investigations
 ascites
 nausea and vomiting Provide appropriate treatment:
 constipation  understand relevant pharmacology i.e. which drugs
 bowel obstruction are commonly used for the control of symptoms,
 diarrhoea usual frequency of administration, typical doses and
 stomas common adverse effects
 rectal discharge  explain relevant non pharmacological treatment
 squashed stomach syndrome options and their appropriate uses
 oral candidiasis
 dry mouth
 dysphagia
 cachexia
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Demonstrate the ability to determine the cause of, and

manage respiratory system problems experienced by Demonstrate knowledge of relevant anatomy and
patients including: physiology
 cough
 dyspnoea Undertake appropriate assessment of symptoms
 superior vena cava obstruction
 death rattles Undertake appropriate examination and investigations
 choking
 tracheostomy Provide appropriate treatment:
 hiccoughs  understand relevant pharmacology i.e. which drugs
are commonly used for the control of symptoms,
usual frequency of administration, typical doses and
common adverse effects
 explain relevant non pharmacological treatment
options and their appropriate uses
manage genito-urinary system problems experienced by Understand relevant anatomy and physiology
patients including:
 dysuria Undertake appropriate assessment of symptoms
 haematuria
 urinary tract infection Undertake appropriate examination and investigations
 incontinence
 fistulae Provide appropriate treatment:
 uraemia  understand relevant pharmacology i.e. which drugs
 contraception are commonly used for the control of symptoms,
 decreased urine output usual frequency of administration, typical doses and
 vaginal bleeding and discharge common adverse effects
 bladder innervation  explain relevant non pharmacological treatment
 urinary frequency and urgency options and their appropriate uses
 bladder spasms

manage neurological disturbances experienced by
Understand relevant anatomy and physiology
patients including:
 convulsions
Undertake appropriate assessment of symptoms
 spinal cord compression
 twitching
 confusion Undertake appropriate examination and investigations
 delerium
 hypercalcaemia Provide appropriate treatment:
 understand relevant pharmacology i.e. which drugs
Demonstrate the ability to manage psychological
disturbances experienced by patients including: Understand relevant anatomy and physiology
 anxiety/panic attacks
 insomnia
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 depression Undertake appropriate assessment of symptoms

 suicide risk
 terminal restlessness Undertake appropriate examination and investigations
Provide appropriate treatment:

 understand relevant pharmacology i.e. which drugs
Demonstrate the ability to determine the cause of and
manage musculoskeletal system and skin problems
experienced by patients including: Understand relevant anatomy and physiology
 deep vein thromboses
 pathological fractures Undertake appropriate assessment of symptoms
 wounds and pressure areas
 pressure areas Undertake appropriate examination and investigations
 pruritus
 dry skin Provide appropriate treatment:
 lymphoedema  understand relevant pharmacology i.e. which drugs
4. Psychosocial and Spiritual Support

Recognise and provide support for the psychosocial and Provide accurate and comprehensible information about
spiritual needs of patients and their family and friends diagnosis and/or deterioration to patients and carers in a
sensitive manner
Be skilled in active listening
Be aware of the range of and differing psychological

reactions to chronic illness, grief and loss experienced by
patients and carers and ways to provide support
Be aware of the impact of a terminal illness on patients

and carers in particular: the loss of independence, role,
appearance, sexuality and perceived self worth
Help patients and families and friends deal with practical,

financial and legal issues where appropriate
Be aware of the importance of seeking appropriate help
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in responding to the spiritual needs and questions of the

patient
Be aware of the impact of family dynamics, cultural,

social, and religious differences on all aspects of
palliative care
5. Organisational Aspects of Care

Provide practical support for the patient and family Be familiar with the range and quality of palliative care
resources in the community e.g. home care, hospital,
hospice and how to access this care including:
 appliances
 physiotherapy
 community support services e.g. community nursing,
meals on wheels
Understand the range of medico-legal and statutory

Understand the duties and responsibilities of the
responsibilities including:
rural/remote doctor after death
 certification of death
 cremation regulations
 liaison with coroners office
 the role of the undertaker
6.1 Ethical Responsibilities

Seek to provide the highest possible quality of life for the Respect the need for maintenance of autonomy by giving
patient and carers through the palliative care process the patient and family a central role in determining
treatment
Respect the right of patients and carers to have his/her

beliefs, needs and wishes recognised and respected
Understand the issues surrounding requests for

euthanasia
Demonstrate respect for life and acceptance of death as

a natural part of living
Weigh up the benefits and burdens of treatment
Assess the risks versus the benefits of each clinical

decision
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Evaluate the decisions involved in the allocation and use

of resources
6.2 Professional Considerations

Appreciate the particular need and difficulty in Understand the importance of establishing protocols
staff
Collaborate and work effectively with other team Appreciate the skills and contributions of others both
members, other health care providers and volunteers to medical and non-medical to palliative care
provide optimal patient care
Understand the concept of teamwork
Demonstrate the ability to work in a multi-disciplinary

team, understanding boundaries and professional
rivalries
Cemonstrate an ability to recognise one’s own limitations Demonstrate an awareness of local issues which impact
and appropriately determine when to refer on the decision to treat or refer
Outline strategies for self care and self reliance Demonstrate awareness of the effects and boundaries of
working as a health professional in small communities

network
6.15.5 Resources/Reading
Ipswich and West Moreton Division of General Practice. (1995) The Blue Book of Palliative Care: A Handbook for
General Practitioners. Ipswich and West Moreton Division of General Practice.
6.15.6 References
The composition of this curriculum statement is based on material sourced from the following publications:
1. Ipswich and West Moreton Division of General Practice. (1995) The Blue Book of Palliative Care: A Handbook for
General Practitioners. Ipswich and West Moreton Division of General Practice.
2. Association for Palliative Medicine of Great Britain and Ireland. Palliative Medicine Curriculum. Association for
Palliative Medicine of Great Britain and Ireland.
3. Australian and New Zealand Society for Palliative Medicine. Undergraduate Curriculum.
http://www.anzspm.org.au/education/ugc/ (12 January 2000).
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Section Two

Dr Andrew Binns
Dr Will Cairns
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Section Two
6.16 POPULATION HEALTH
6.16.1 Context

Medical school term in social and preventive medicine or equivalent

Aboriginal Health

Sociology of Rural and Remote Communities, Tropical Health (elective), Remote Health, Information Technology,
Practice Management

The registrar will:
 demonstrate a commitment to the application of population health principles in the provision of health services to
rural/remote communities
 demonstrate the knowledge and practical skills required to integrate population health strategies into routine
general practice
 understand the importance of the local management of population health issues and the leadership role required
of rural/remote doctors in promoting interprofessional collaboration, and
 demonstrate a commitment to self-directed learning, continuing education and the conduct of quality
improvement activities in the provision of population health services in rural/remote practice.
1. Background Knowledge 5. Designated Public Health or Medical Advisory Roles

2. Individual Patient Care 6. Occupational Health and Safety
3. Health Services/Practices 7. Professional and Ethical Responsibilities
4. Local Community Activity
6.16.4 Content

Outline the characteristics of current population health Outline the relative merits and limitations of the following
strategies and activities current population health strategies including:
 clinical care
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 health enhancement
 risk avoidance
 risk education
 secondary and tertiary prevention activities
 referral of patients and their families to:
 health information
 health enhancement activities
 support groups
Be aware of current population health initiatives and the

role of rural and remote general practitioners, including:
 National targets and priority areas and population
health activities
 State and community health promotion and
population health activities
Describe the social, cultural, racial, geographical and

Demonstrate an understanding of the characteristics of environmental characteristics of rural/remote
rural/remote communities that impact on population communities that have an impact on:
health service needs  risk factors
 health patterns
Recognise the clinical manifestations of these factors
Outline the range of approaches to managing them
Compare/contrast these characteristics with urban

populations
2. Individual Patient Care

Elicit appropriate population health historical information View population health as an integral part of quality
patient care
Routinely elicit relevant information about a patient’s

potential environmental, social and behavioural risk
factors when taking a medical history:
 consider such information in clinical decision making
 collect such information in ways that may contribute
to broader population health data
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Be familiar with the principles of and demonstrate

Undertake health promoting or preventive interventions competence in undertaking the following interventions:
for which there is evidence of efficacy and cost  health enhancement
effectiveness  counselling and education
 screening and early detection
 monitoring of established disease
 immunisation and chemo-prophylaxis
Educate and inform individuals and/or their families

about their health including:
 risk avoidance
 risk education
 guidance towards additional resources in the
practice or community
Collaborate with patients, families and other health care

Demonstrate a commitment to the principles of providers to develop mutually acceptable and optimal
coordination of care and the provision of continuity of care plans
care
Describe the consent and confidentiality requirements
Appreciate the role and ethical considerations of related to enrolling patients in recall and reminder
recall/reminder systems systems
Inform patients and staff of the consent and

confidentiality requirements related to enrolling patients
in recall and reminder systems
Act appropriately on recall and reminder systems to:

 access information on the status of disease
prevention and health promotion activities in the
individual
 undertake due activities
 record action taken
Undertake a flexible approach to consulting with people

from different cultural and social backgrounds
Demonstrate an appreciation of local social and cultural
milieu Utilise local resources to establish credibility and achieve
effective communication
Describe the process for informing health authorities of

adverse health impacts, unusual events or trends which
Demonstrate familiarity with local population health may require further investigation or action
protocols
Communicate coherently with population health
authorities
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Articulate patient needs and present to relevant health

related services
Advocate for individuals or their families regarding health Network to ensure outcomes
related issues such as housing, water and social
services as required Undertake clinical audits of own activity and evaluate the
outcomes against evidence based guidelines including:
 quality of patient record keeping
Demonstrate a commitment to continuous quality  screening/early detection frequency
improvement in one’s practice  diagnostic testing
 rational prescribing
 referral, including referral to non-medical therapeutic
support and health promotion activities
 cost effective management
3. Health Services/Practices

Analyse gaps in health promotion activity provided in the Identify existing and evolving significant community
community and identify ways the health service/practice morbidity patterns
can fill them
Communicate these issues to practice team, local allied
health workers and community
Develop and implement health service/practice health Describe the steps involved in planning health service
promotion and prevention initiatives health promotion and prevention activities including:
 identification of practice priority areas
 who the service targets
 educational activities such as counselling and
provision of education materials
 types of recall and reminder systems and levels of
coverage
 response to local and national health priorities
 advocacy for practice populations groups
Describe current best practice in relation to the following

Adopt and review best practice protocols and guidelines activities:
in relation to population health activities  health enhancement
 education for risk avoidance
 education of those with risk factors
 activities to reduce complications of established
disease
 care planning and coordination of care
 rational prescribing
 referral and access of patients and their families to:
 health information
 health enhancement activities
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 support groups
Describe the role of practice infrastructure in supporting

routine practice population health activities including:
Demonstrate an understanding of the systems and  information management systems and stationery
structures necessary to support the integration of  information technology
preventive and promotive activity into routine practice  staff roles and participation
activity  staff access to information and guidelines
 staff training
 knowledge of agencies from whom information and
support may be obtained
 on-going evaluation and quality improvement
4. Local Community Activity

Identify the risk factors, health problems and health In relation to specific behavioural, social, environmental
needs of the community, and advise on, act or advocate and geographic risk factors and health problems:
for risk reduction and health enhancement  describe local risk factors and health problems
 recognise their clinical manifestations
 describe the range of approaches to managing them
 prevention and health promotion strategies
 clinical management
 describe responsible agencies/persons
 initiate study of local risks and problems to provide
information for management
 access information, advice and support for these
activities as required
Work effectively with community groups, non-

Constructively participate in a range of community based government organisations and government agencies
population health activities
Identify health needs of the community and special
groups within it, with emphasis on high risk and priority
groups
Contribute to the planning, conduct and evaluation of

community based health promotion and community
development activities
Plan, conduct and evaluate community based health

Advocate on health and health service issues as

required by the community
Disseminate population health information in a timely

and balanced way to the community and the media
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Participate in the development of local clinical practice

guidelines, based on evidence and contextualised for
local primary health care settings
5. Designated Public Health or Medical Advisory Roles

Fulfil the legislative reporting requirements relevant to Describe the processes for alerting relevant
public health or medical advisory roles organisations to health problems and risk factors and
advising on their management
Advise on the management of outbreaks
Access advice and support on health problems and risk

factors and their management
Initiate preventative and health promotive activities

relevant to these roles
6. Occupational Health and Safety

Demonstrate an understanding of the risk factors and Identify the characteristics of the local workforce in
health problems within local working environments and relation to:
advise on or advocate for risk reduction and health  local conditions and hazards
enhancement  the range of associated health problems
 their clinical manifestations
 the range of approaches to managing hazards and
health problems, including:
 workplace standards and laws
 prevention and harm minimisation strategies
 clinical management
 responsible individuals and agencies in the
workplace and the community and the protocol for
dealing with them including:
 workplace clinical staff
 workplace health and safety officers
Describe the range of physical, mental, chemical,

Demonstrate an understanding of the common health radiation and environmental hazards that may occur in
risks/hazards that may occur in the workplace the workplace
Access data relating to:

Comprehend medico-legal occupational health and  health problems and risks
safety responsibilities and issues  occupational health and safety standards and laws
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 workers compensation law
Bring health problems and risks and health service

needs to the attention of relevant individuals and
Undertake local occupational health and safety advocacy agencies
Advocate for change in work practice and environments

in order to reduce risk and enhance health
Contribute to the planning, conduct and evaluation of

workplace health education and health promotion
activities
Identify barriers to change in workplaces
Work effectively with groups and individuals in order to

optimise health outcomes
Initiate studies on hazards and health problems and their

management as required
Disseminate information in a timely and balanced way to

the community and the media, if required
Plan, conduct and evaluate workplace based health

Undertake appropriate:
 initial and ongoing medical assessments
 recording of information
Complete statutory requirements of a medical officer  investigation and referral
 liaison and reporting to employees and company
authorities

Appraise satisfactory clinical performance Critically reflect on consultations and community based
activities to identify strengths and opportunities for
development
Demonstrate a commitment to the principles of

Undertake responsibilities for ongoing patient care coordination of care and the provision of continuity of
care
Demonstrate the ability to collaborate with other team

Appropriately and effectively participate in multi- members and other health care providers to provide
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disciplinary health care teams optimal patient care

Outline strategies for self care and self reliance network

Advise individuals on conditions affecting the health of

Demonstrate an understanding of the importance of the the community at large, e.g. rubella.
maintenance of integrity of rural/remote doctors as
individual patient care providers and as advocates in Appreciate the duty to protect patient’s interests when
population health and occupational health matters negotiating with employers regarding work related
illnesses e.g. terms and conditions for patients partially fit
to return to work

The principal content of this curriculum statement is derived primarily and extensively from the following reference
document:
Maggie Grant. 1999. Population Health Education for Clinicians Project. Workforce Branch of the Commonwealth
Department of Health and Aged Care.
Working Party
Ms Maggie Grant
Professor David Prideaux
Dr Chris Holmwood
Ms Vicki Sheedy

Ms Jo Wainer
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6.17 PSYCHIATRY/MENTAL HEALTH
6.17.1 Context

Medical school unit in psychiatry, PGY1

Child and adolescent health, adult internal medicine, emergency medicine

Population health, Aboriginal and Torres Strait Islander health, sociology of rural and remote communities

The registrar will:
 demonstrate a working knowledge of mental disorders and mental health problems that commonly present in
rural and remote general practice
 demonstrate the knowledge, skills and attitudes necessary to assess, diagnose and manage patients with
mental health problems or disorders in the rural/remote context
 demonstrate appropriate interviewing, counselling and education techniques necessary to manage patients with
mental health problems or disorders in the rural/remote context
 demonstrate the capacity to manage psychiatric emergencies in the rural/remote context
 understand the extended care responsibilities in managing patients with mental health problems or disorders in
the rural/remote context
 demonstrate a commitment to uphold the rights of people with a mental health problem or disorder and to
encourage and support the participation of patients, family members and/or carers in determining their treatment
and care, and
activities in the provision of mental health services in rural/remote practice.
1. Background Knowledge 7.1 Children

2. Rights of Patients with a Mental Illness 7.2 Adolescents
3. Mental Disorders and Mental Health Problems 7.3 Adults
4. Mental Health Status Examination 7.4 Aged
5. Patient Management 8. Promotion and Prevention
6. Psychiatric Emergencies 9. Research and Evaluation
7. Mental Health Problems in Specific Age Groups 10. Professional and Ethical Responsibilities
6.17.4 Content
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Demonstrate an understanding of the philosophy of Outline the history of the development of psychiatry and
mental health care and the role of the rural/remote doctor theories of personality
in providing this care
Outline current national mental health priorities and
policies and their application to rural/remote general
practice
Demonstrate sensitivity to the social, cultural and

spiritual values of people of diverse backgrounds and
practice in a culturally appropriate manner
Recognise the social, cultural, ethnic, geographical and

Demonstrate an understanding of the characteristics of environmental characteristics of rural/remote
rural/remote communities that impact on the mental communities that have an impact on the presentation
health needs of those communities and management of mental health problems including:
 risk factors
 health patterns
Recognise the clinical manifestations of these factors
Outline the range of approaches to managing them
2. Rights of Patients with a Mental Illness

Uphold the rights of people affected by mental disorders Understand and comply with relevant national and state
or mental health problems and their family members legislation related to the rights of people with a mental
and/or carers and ensure their safety, privacy and illness and the improvement of mental health care
confidentiality including:
 relevant state Mental Health Act
 legislation on:
 child protection
 privacy
 confidentiality
 guardianship
 freedom of information
 anti-discrimination
 legislation related to informed consent for treatment
 mechanisms for involuntary treatment and care
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according to state or territory mental health

legislation
 reporting requirements and record keeping of state
legislation including:
 child abuse
 elder abuse
 domestic violence
 critical incidents
Be aware of and understand guidelines for dealing with

anger, self-harm, violence and aggression developed at
national, state or local level
Appropriately use evidence based interventions and

treatments
3. Mental Disorders and Mental Health Problems

Demonstrate you are knowledgeable about mental Demonstrate a basic understanding of the aetiology and
disorders and mental health problems and apply this pathogenesis of mental health disorders including:
knowledge in all aspects of their work  depression
 minor
 major
 anxiety disorders
 generalised anxiety disorder
 acute stress disorder
 adjustment disorder
 obsessive compulsive disorder
 panic disorder
 post traumatic stress disorder
 sleep disorders
 personality disorders
 psycho geriatrics
 dementia
 depression
 delirium
 psychoses
 bipolar
 unipolar
 schizophrenia
 toxic and organic brain syndromes
 substance abuse
Be familiar with the nature, natural history, incidence and

prevalence of mental disorders across the lifespan and
current psychiatric diagnostic classification systems
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4. Mental Health Status Examination

Take a comprehensive mental health history, conduct a Effectively communicate with patients in a respectful,
mental status examination and formulate a diagnosis empathetic and empowering manner possessing:
 effective listening skills
 an appreciation of different patient cultural and
social beliefs and practices
 an appreciation of different patient decision making
processes
 an ability to interpret body language
 an ability to recognise hidden agendas
Recognise the signs and symptoms of mental disorders

and mental health problems taking into consideration
differences in presentation that may occur in the
rural/remote environment
 recognise and assess early signs and symptoms of
a mental disorder
 understand the importance of early diagnosis and
treatment and the maintenance of therapeutic
momentum in the effective management of mental
health problems
Identify the indicators for normal mental status
Identify the indicators for routine psychiatric consultation
Identify the indicators for emergency psychiatric

consultation
Identify the indicators for and specific needs of those

with mental health disorders combined with co-existing
co-morbidity problems including:
 substance abuse
 developmental disability
 physical disability
 personality disorder
 trauma
 brain injury
 hearing or sight impairment
Identify the indicators for coexisting psychiatric

morbidities
Competently use diagnostic classification systems and

information from patients and relevant others to assist in
determining diagnosis and recognise when diagnostic
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classification systems may not be appropriate
Accurately and comprehensively document the

information obtained on the patient’s mental health
status during the consultation
Differentiate between organic and functional causes of

altered mental status
5. Patient Management

Develop a comprehensive care plan based on Work in partnership with patients, families and other
knowledge of the nature, causes, clinical course and health care providers (as appropriate) to develop
prevalence of mental disorders and mental health mutually acceptable and optimal treatment and care
problems plans, setting measurable and achievable goals
Work in partnership with patients, families and other

health care providers (as appropriate) to develop
strategies for relapse prevention
Outline the pharmacokinetics, indications,

contraindications and side effects of the major
psychotherapeutic agents
Interpret and apply appropriate national clinical practice

guidelines to assist in determining best practice patient
management strategies
Assess potential risks to self and other care providers

and plan and document accordingly interventions/service
provision
Outline the range of current therapeutic modalities and

regimes
Discuss the principles of the range of behavioural

therapies and their relative merits and limitations
including:
 family therapy
 group therapy
 individual therapy both cognitive and dynamic
 psychosocial education
Identify the available community facilities/resources and

means of access in the local area
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Deliver appropriate counselling and behavioural therapy

while recognising own limitations
Provide treatment using a range of interventions and in
collaboration with other community and/or government Manage pharmacotherapy for the full spectrum of mental
organisations as appropriate and relevant illness including monitoring and managing adverse
affects of medication
Establish mechanisms to empower individuals to seek

treatment when relapse occurs
Provide appropriate education and information to

patients, families and carers on relevant psychiatric
illnesses:
 screen and advise patients, families and carers on
the reliability and validity of information on mental
health disorders and problems obtained in the public
arena ie. on the Internet
Provide support for and advice to family members and

carers
Demonstrate skills and knowledge in using emerging

technology such as telepsychiatry facilities as
appropriate
Monitor and review planned interventions at appropriate

intervals and revise as necessary
Identify benchmarks for determining treatment

conclusion and capacity of patient to conclude
intervention
Plan and work towards a conclusion of the intervention Determine plan for terminating intervention including:
process as appropriate  exit process
 ongoing support required
Recognise the importance of multi-disciplinary team work

and the extended role of other health professionals in
developing and implementing patient management
Work in partnership with other health service providers Recognise the differing availability of mental health
and relevant community organisations to ensure that resources in rural/remote communities and demonstrate
patients’, family members’ and/or carers needs are met the ability to improvise when necessary
Establish and utilise a mental health referral and

advisory network
Appreciate the need to provide leadership (where

appropriate), team management and foster
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interprofessional collaboration to facilitate optimal patient

management
Be familiar with the spectrum of self help and carer

organisations which exist to assist patients and carers
including their role, how to access them, etc.
6. Psychiatric Emergencies

Demonstrate the skills required to competently manage a Competently respond to a crisis or emergency situation
mental health crisis including:
 assessing potential risks and adverse reactions of
patient eg:
 suicide risk
 violence to others
 damage to property
 signs of drug overdose
 current severity of psychiatric illness
 crisis intervention
 aggression management
 acute situational crisis counselling
 conflict resolution
 violence interventions
 debriefing
 protocols for media management

patients who require specialised care
Be aware of the availability of guns in local community
Outline relevant state legislation regarding:

 involuntary admission to a psychiatric unit
 power of attorney
 child protection and abuse
 guardianship
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7. Mental Health Problems in Specific Age Groups
7.1 Children

Demonstrate competence in assisting child patients with Understand the specific approaches and techniques
their specific mental health problems in the context of the required in engaging and working with children
Diagnose and manage common mental health problems
Note: See also Child and Adolescent Health Curriculum children experience including:
Statement  the difficult child, discrimination of the physical
factors from the psychological
 encopresis and enuresis
 school refusal
 attention deficit disorder
 aggression
 organic brain disorder
 oppositional defiancy disorder
 loss and grief reaction
 recognition of sexual abuse
 recognition of child abuse
Be able to effectively communicate with children
Be capable of exploring and understanding the

psychodynamics of family unit particularly as it relates to
the child
7.2 Adolescents

Demonstrate competence in assisting adolescents with Define the main features of adolescent psychology and
their specific mental health problems in the context of the the common forms of adolescent mental illness
Recognise, diagnose and manage common mental
Note: Cross reference with Child and Adolescent Health health problems adolescents experience including:
Curriculum Statement  relationship problems at home, school, with peers
 low self esteem
 peer group imitation
 oppositional behaviour
 tendency to self harm
 substance abuse
 alcohol dependence
 amphetamine dependence (stimulants, speed,
uppers, diet pills)
 cannabis dependence
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 cocaine dependence (coke, crack)

 hallucinogen dependence (psychedelics, LSD)
 inhalant dependence (sniffing: glue, petrol,
solvents)
 nicotine dependence (tobacco)
 opioid dependence (heroin, methadone,
morphine)
 phencyclidine dependence (PCP, angel dust)
 sedative dependence (sleeping pills,
barbiturates, valium)
 intoxication and withdrawal syndromes
 pharmacotherapeutics
 recognise the potential for substance abuse to
create mental illness
 depression
 psychoses
 early teenage pregnancy
 eating disorders
 loss and grief reaction
 sexual abuse
Demonstrate ability to effectively communicate with

adolescents
Demonstrate techniques of engagement with

adolescents, clearly demonstrating confidentiality and
sympathy of approach
Be familiar with the establishment of support networks as

a strategic treatment tool, involving family where
appropriate, encouraging conciliation in a tactful manner
7.3 Adults

Demonstrate competence in assisting adult patients with Recognise and assist patients with:
their specific mental health problems in the context of the  relationship difficulties
Demonstrate an understanding of the dynamics of
personal relationships especially in rural settings
 substance abuse
 (see list above)
Possess skills in
 conflict resolution
 marriage guidance
 family dynamics and parenting issues
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7.4 Aged

Demonstrate competence in assisting older patients with Diagnose and manage common mental health problems
their specific mental health problems in the context of the experienced by older patients including:
rural/remote environment  dementia
 depression
 delirium
8. Promotion and Prevention

Undertake community education and health promotion Recognise the biological, social, environmental and
activities to increase the communities awareness and economic factors which impact on health and illness at a
understanding of mental health issues and mental health personal, local and global level
disorders
Identify local risk behaviours and specific needs of local
community for community education and mental health
promotion
Undertake activities in the community to increase

community awareness of:
 strategies for promoting and maintaining good
mental health
 mental health problems and disorders
 co-morbidity
Reduce stigmatising and stereotyping attitudes towards

mental health problems and disorders
9. Research and Evaluation

Critically evaluate published literature and research Understand the various study designs and
pertaining to psychiatry and mental health issues methodologies used in bio psycho social research
Understand basic statistical methods and their

interpretation
Update knowledge in light of emerging research and

incorporate appropriate findings into practice
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Critically appraise their own knowledge base and Monitor level of education, knowledge and skills in
performance regard to the above competencies
Demonstrate an ability to recognise limitations in their

knowledge and expertise and appropriately determine
when to seek expert advice and refer:
 be aware of local issues which impact on the
decision to treat or refer, such as local transport and
evacuation processes
Understand and comply with relevant legislation and

Appreciate the particular need for and difficulty in
regulations protecting patient privacy, confidentiality and
maintaining patient privacy and confidentiality in
access to information
rural/remote communities
staff
Be aware of the effects and boundaries of working as a

Outline strategies for self care and self reliance mental health professional in small communities
Describe strategies for balancing the needs of a busy

practice with the ongoing needs of patients with mental
health problems

network

The content of this document is derived from the ACRRM Prospectus1 Psychiatry Position Paper. The document has
been adapted to be consistent with the format and framework of the ACRRM Primary Curriculum. In 2002, this
curriculum statement was updated in accordance with the standards for mental health professionals outlined in the
National Practice Standards for the Mental Health Workforce document developed by the National Mental Health
Education and Training Advisory Group.
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Prospectus Working Group

Dr David Cooke
Dr Alan Bremner
Dr Robert Campbell
Dr Rodney Catton
Dr Graham Fleming
Dr Kay Griffiths
Dr Malcolm Isles
Dr Ian Kamerman
Dr Paul Karen
Dr Aidan Lawrence
Dr Iain MacLeod
Dr Frank Marton
Dr Gregory Mossop
Ms Anna Nichols
Dr Louise Stone
Dr Bronwyn Williams

Professor Peter Yellowlees
Dr Mike Moynihan
Dr David Campbell
Dr Nicholas O’Ryan
Ms Vicki Sheedy
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6.18 RADIOLOGY
6.18 RADIOLOGY
6.18.1 Context

Medical school and postgraduate radiology education and experience. Medical school studies in anatomy and
pathology, Accident & Emergency experience.

State Radiography Licensing Training and Education for Rural and Remote GPs who practice radiography.

Radiography, Ultrasonography, Radiology components of the Early Management of Severe Trauma (EMST) course,
Orthopaedics and Fracture Management.

The registrar will:
 demonstrate a systematic approach for detecting findings on radiographs

 demonstrate competence in reading, interpreting and reporting on skull, spinal, abdominal, skeletal and chest
radiology
 demonstrate knowledge and awareness about which diagnostic imaging modalities are most effective in clinical
practice
 demonstrate the ability to provide a safe, accurate diagnostic imaging service
 demonstrate confidence and skill in undertaking skull, spinal, abdominal, skeletal and chest radiology
 demonstrate basic skills in interpreting and reporting paediatric radiology
 demonstrate basic experience and skill in ultrasonography
 demonstrate competence in trauma radiology
 demonstrate knowledge of obstetric radiology
 demonstrate expertise in basic contrast studies in radiology
 demonstrate the ability to follow imaging guidelines, and
 demonstrate a basic understanding of some of the more sophisticated Diagnostic Imaging Modalities in clinical
practice including Computer Tomography (CT), Magnetic Resonance Imaging (MRI), Radio-Isotope Studies,
Mammography, Image Intensifier Services etc.
1. Anatomy 7. Abdominal X-ray

2. Management of Severe Contrast Reaction 8. Obstetric Ultrasonography
3. Normal Chest X-ray 9. Urography
4. Abnormal Chest X-ray 10. General Imaging Guidelines
5. Chest X-ray of Neonates, Infants and Young Children 11. Diagnostic Imaging Modalities in Clinical Practice
6. Skeletal X-ray 12. Reporting on X-ray
6.1 Skull and Facial Bone X-rays 13. Professional and Ethical Responsibilities
6.2 Spinal X-ray
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6.18 RADIOLOGY
6.18.4 Content
1. Anatomy

Demonstrate a working knowledge of basic anatomy Identify the main bones and organs of the body
Describe normal radiographic features of bone, chest,

heart, kidneys and ureters, skull and spine
Demonstrate knowledge of developmental radiology and Describe the variable appearance of paediatric
normal variants radiographs including normal variants
Describe the means of confirming such normal variants

e.g. x-ray other side, refer to reference text on normal
variants, interval x-ray
2. Management of Severe Contrast Reaction

Demonstrate a working knowledge of emergency Handle a severe contrast reaction
management of severe contrast reaction
Appropriately prescribe medications to treat acute
allergic reactions:
 adrenaline
 steroids
 anti-histamines
 IV saline
Perform cardio-pulmonary resuscitation
3. Normal Chest X-ray

Demonstrate competence in reading, interpreting and Identify the normal features of a chest x-ray including:
reporting on normal chest x-rays including:  lung fields
 Posterior/Anterior (PA)  hilum
 Antero-Posterior (AP)  ribs
 lateral view (only used when Posterior / Anterior  thoracic inlet/trachea
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6.18 RADIOLOGY
view has been inspected)  sternum

 oblique view  diaphragm/costophrenic angles
 sterno-clavicular joints
 bronchus
 pulmonary arteries
 cardiac outline
Outline the advantages and disadvantages of different x-

ray views of the chest, including portable films, being
aware of:
 different appearance of AP versus PA projections
 limitations and altered appearance of portable films
 use of expiratory films to diagnose pneumothorax
Appropriately choose radiographic projection
Systematically apply search patterns in interpreting chest

x-rays (grocery list search strategy, Richardson, 2000)
Detect technical faults mimicking disease and affecting

film quality including:
 defects in developer, fixer
 recognition of poor film quality due to under or over
exposure or bodily habitus such as extreme obesity
 interpret normal heart borders on x-ray
4. Abnormal Chest X-ray

Demonstrate competence in reading, interpreting and Identify pathological conditions able to be diagnosed by
reporting on abnormal chest x-rays chest x-ray
Systematically apply search patterns in interpreting

abnormal chest x-rays
Apply radiological skills and expertise in the diagnosis of

the following conditions:
 pain in chest, acute chest trauma
 closed chest injuries, penetrating chest injuries
 inhaled foreign body
 pleural effusions, loculated effusion
 pneumothorax, hydropneumothorax
 pulmonary collapse/atelectasis
 widened mediastinum (aortic aneurysm appearance,
mediastinal pathology or tumours e.g. thymoma)
 densities in the lungs
 emphysema
 bronchitis, asthma, COPD, pulmonary contusion
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6.18 RADIOLOGY
 pneumonia (inflammatory consolidation),

staphylococcal pneumonia
 bacterial pulmonary (lung) abscess, amoebic lung
abscess
 acute tuberculous cavitation
 pulmonary tuberculosis with cavity formation
 enlarged lymph nodes (abnormal hilar patterns such
as sarcoidosis, bronchial carcinoma etc.)
 hydatid cysts
 primary lung cancer, secondary (metastatic) lung
cancer
 mycetoma (fungus ball)
 diffuse increase in lung pattern
 pneumoconiosis (industrial disease)
 pulmonary embolism/infarction
 cardiac failure such as:
 Kerley “B” lines
 batswing shadowing
 left ventricular hypertrophy
 atrial enlargement
 obliteration of costophrenic angles
 altered upper/lower lobe perfusion
 enlarged heart
 pericardial effusion and cardiomyopathy
 pulmonary oedema
Interpret x-ray of the lateral view of the heart
5. Chest X-ray of Neonates, Infants and Young Children

Demonstrate competence in reading, interpreting and Identify appropriate views for chest radiography in
reporting on chest radiographs of infants and young children
children
Know the differences between adult and child chest
radiographs
Identify technical faults in paediatric chest x-ray (poor

inspiration, thymus)
Diagnose diaphragmatic hernia in neonates
Appropriately interpret trauma and foreign objects on

chest radiography in children
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6.18 RADIOLOGY
6. Skeletal X-ray

Demonstrate competence in reading, interpreting and Display a working knowledge of the musculoskeletal
reporting on skeletal x-rays system
Outline the general principles of skeletal radiology

skeletal x-rays
Recognise common and uncommon abnormalities of

bony architecture due to:
 infection (osteomyelitis)
 inflammation
 degenerative disease (osteoporosis)
 metabolic disease
 inherited abnormalities
 osteogenesis
 imperfecta
 dwarfism
 benign lesions
 neoplasia (multiple myeloma, primary bone tumours,
bony metastases etc)
 injury
 Paget’s disease, osteomalacia/rickets, bone cysts
etc.
N.B. Attention should be made to periosteal, cortical and

medullary components
Detect common fractures of:

 shoulder girdle
 clavicle
 acromio clavicular joint
 scapula
 upper limb
 ulna
 humerus
 radius
 wrist
 forearm
 elbow
 hand
 ribs
 pelvic girdle
 hip
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6.18 RADIOLOGY
 sacrum
 coccyx
 lower limb
 femur
 tibia
 fibula
 knee
 ankle
 foot
Recognise the important aspects of appropriate

evaluation of any fracture including:
 displaced/non-displaced
 simple/comminuted
 presence of foreign bodies
 associated soft tissue injury
 localised oedema
 surgical emphysema
 gas gangrene
 joint or growth plate involvement
 special risks or complications
 precautions (particularly “readily missed”)
Recognise common joint dislocations, subluxations and

epiphyseal injuries
 slipped femoral epiphysis
Recognise common prosthetic appearances such as:

 hip/knee replacements
 spinal fusion procedures
Evaluate multiple injuries including those due to child

abuse

the following joint conditions:
 osteoarthritis
 gout
 ankylosing spondylitis
 Perthe’s disease
 arthritis (see Richardson’s rules of arthritis – in
online textbook)
6.1 Skull and Facial Bone X-rays

Demonstrate competence in reading, interpreting and Describe and recognise normal skull x-rays
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6.18 RADIOLOGY
reporting on skull and facial bone x-rays

Appropriately use skull x-rays in the investigation of
Note: See also Emergency Medicine Curriculum suspected head trauma, recognising their limited clinical
Statement application (refer to Imaging Guidelines, Royal
Australasian College of Radiologists, 1997, p 18 for
further information)
Systematically apply search patterns in interpreting skull

and facial bone x-rays

the following conditions:
 depressed head fracture
 penetrating head injury
 facial trauma
 lytic defects in skull
 dense areas in skull
 salivary calculus
 orbit injury
6.2 Spinal X-ray

Demonstrate competence in reading, interpreting and Know the characteristics of:
reporting on spinal x-rays  normal cervical spine
 normal thoracic spine
 normal lumbosacral
 normal coccyx

spinal x-rays
Accurately interpret and report on radiography for:

 ageing
 kyphoscoliosis
 spinal trauma
 changes in vertebral density and outline without
injury
 vertebral body outline
 back problems
 fractured pelvis recognition
 metastatic lesions
Demonstrate a working knowledge of the management

of cervical spine trauma
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6.18 RADIOLOGY
7. Abdominal X-ray

Demonstrate competence in reading, interpreting and Describe indications for abdominal radiography
reporting on abdominal radiographs
abdominal radiographs
Interpret plain abdominal x-ray
Accurately interpret and report on radiography of:

 intestinal obstruction
 small bowel
 large bowel
 ileus
 normal bowel patterns
 faecal loading
 pseudo obstruction
 perforation of the gut
 foreign bodies
 abdominal calcifications – search pattern and
differential diagnosis
 cholelithiasis
 renal calculi
 ureteric calculi
 bladder calculi
 lymph node calcification
 phleboliths
 pelvis (uterine fibroids, dermoid cysts)
 calculi in the prostate
 vascular calcification
Recognise abdominal mass in children
8. Obstetric Ultrasonography

Demonstrate competence in basic obstetric ultrasound Perform basic diagnostic ultrasound in pregnancy
Note: GPs who wish topractice ultrasonography will need Be aware of the limitations and medico-legal dangers of
to do a complete accredited course in this specialty. performing ultrasound, particularly in pregnancy
Note: See also Obstetric Ultrasound Curriculum Be aware of the limitations of ultrasound in certain
Statement conditions and particularly in larger patients
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6.18 RADIOLOGY
9. Urography

Demonstrate competence in reading, interpreting and Systematically apply search patterns in interpreting
reporting on urography and radiography of the renal radiographs of the urinary system
system
Accurately interpret and report on:
 plain film of urinary tract
 calcification in the renal area
Be familiar with urography procedures:

 describe the major clinical indicators for urography
 preparation
Understand the basics of interpreting common IVP,

ureteric and vesical contrast studies
Interpret contrast examination of the:

 kidneys
 ureters and bladder (intravenous)
 pyelography antegrade or retrograde pyelography
 retrograde cystography
 retrograde urethrography
 retrograde micturating urethrography
 missing kidney
 variations in anatomy
 calyceal patterns
 large kidney, small kidney, ureters, bladder
 prostatic calculi
10. General Imaging Guidelines

Adhere to recommended imaging guidelines where Refer to recommended guidelines when making choices
possible for imaging (performing or referring)
Note: The two recommended sources are: Order the right test for the right problem (Richardson,
1. Imaging Guidelines (The Royal Australasian College 2000)
of Radiologists, 2001)
2. Effective choices for diagnostic imaging in clinical
practice (WHO, 1990)
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6.18 RADIOLOGY
11. Diagnostic Imaging Modalities in Clinical Practice

Demonstrate a basic knowledge of ‘high-tech’ imaging Be aware of the latest imaging modalities available
technologies including:
 Computer tomography Be aware of the possibilities of teleradiology in
 Magnetic Resonance Imaging (MRI) rural/remote general practice
 radio-isotope studies
 mammography
 image intensifier services
 radio-nuclide scans
12. Reporting on X-ray

Demonstrate competence in undertaking a systematic Accurately report on radiographs (Richardson, 1999),
approach to reporting on x-ray and (American College of Radiology (ACR ) Standard of
Communication: Diagnostic Radiology)

staff
Demonstrate an ability to recognise one’s own limitations Be aware of local issues which impact on the decision to
and appropriately determine when to refer treat or refer, such as local transport and evacuation
processes
network
6.18.5 References
ACR Standard for Communication: Diagnostic Radiology. American College of Radiology. Revised 1999.
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Section Two
6.18 RADIOLOGY
http://www.acr.org/cgi-bin/fr?tmpl:standards02,pdf:pdf/communications_diag_rad.pdf.
Effective Choices for Diagnostic Imaging in Clinical Practice (1990). Report of a WHO Scientific Group. Technical
Report Series 795 (available from Hunter Publications, Melbourne, ($21.28 with GST).
Lau L and James P (Eds) (2001), Imaging Guidelines. 4thEdition. The Royal Australasian College of Radiologists.
Australia.
Palmer P.E.S., Cockshott W.P., Hegedus V, Samuel E (1985) Manual of Radiographic Interpretation for General
Practitioners. World Health Organisation, Geneva, Reprinted 1998 http://www.radiographersreporting.com/
(Radiographer Reporting).
Richardson, M L (1999) Tips for reading chest films. Radiology Review for Primary Care Practitioners.
http://uwcme.org/courses/radiology/threehourtour/interpretation/chestinterp/chesttips.html.
Richardson, M L (1999) Ordering the Right Test for the Right Problem. Radiology Review for Primary Care
Practitioners. http://uwcme.org/courses/radiology/threehourtour/righttests/righttest2.html.
Richardson, M L (1999) Online Textbook. http://www.rad.washington.edu/mskbook/index.html
Training in Diagnostic Ultrasound: Essentials, Principles and Standards. Report of a WHO Study Group, Geneva
1998.
This curriculum statement was developed as part of the ACRRM Radiology Program, which was funded by the
Department of Health and Ageing.
ACRRM Radiology Program Steering Committee

Dr Peter Graham
Dr Bruce Chater
Dr Richard Escott
Dr Mark Robinson
Dr Joe Putman
Dr George Kokar
Dr David Crosbie
Ms Roz Glazebrook

Dr Peter Baker
Dr Dan Manahan
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6.19 REHABILITATION MEDICINE
6.19.1 Context
Medical school studies in anatomy (including neuroanatomy), physiology and pathology

This curriculum statement provides an extra dimension to the curriculum as a whole and supplements other sections.
It also covers some conditions not dealt with elsewhere. A 3 month clinical attachment in a hospital with an out-
patients rehabilitation unit would be advantageous.

These especially include musculoskeletal medicine, industrial health, orthopaedics, surgery, paediatrics, adult
internal medicine, geriatrics, oncology, palliative medicine and gynaecology. Reference to the sullabus statement on
management is appropriate, especially communication skills and the ability to lead and work within a team.

The registrar will:
 demonstrate appropriate knowledge, skills and attitudes to provide comprehensive medical care in the rural
setting, to patients with long term disabilities due to trauma, disease, congenital and degenerative conditions and
pain, in ongoing collaboration with relevant units and providers
 demonstrate basic hands-on skills in the diagnosis, evaluation and treatment of disease, pain and functional
limitations and the prevention of complications in patients with long term disabilities
 demonstrate skills in the education of patients and significant others about the disease and the short and longer
term goals
 demonstrate appropriate knowledge and skills to help restore patients to maximal function and psychosocial
capacities
 understand the GP’s role in maximising the functional abilities of patients, and
 demonstrate the ability to work in close collaboration with other health professionals and community resources.
1. The Rehabilitation Process 7.3 Spinal Injury

2. Communication 7.4 Amputation
3. Coordination of Care 7.5 Orthopaedic
4. Assessment and Evaluation 7.6 Cardiac Disease
5. Treatment 7.7 Pain
6. Rehabilitative Issues in Specific Age Groups 7.8 Chronic Degenerative Conditions
6.1 Children and Adolescents 7.9 Skin Conditions
6.2 Aged 7.10 Neurogenic Bowel and Bladder Disorders
7. Specific Clinical Conditions 7.11 Sexuality
7.1 Stroke 7.12 Cancer and Other Life Threatening Conditions
7.2 Traumatic Brain Injury
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6.19.4 Content
1. The Rehabilitation Process

Demonstrate an understanding of the principles of Appreciate that rehabilitation:
rehabilitation  encompasses physical, psychological, social,
relational, vocational, recreational and educational
issues and needs to be culturally sensitive
 spans primary, secondary and tertiary health care
 involves the use of a health care team at local,
regional and State levels, which may involve/require
multi-skilling of some staff in remote areas
Convey the meaning of impairment, disability and

handicap
2. Communication

Demonstrate an understanding of, and skills in effective Provide effective and appropriate counselling to patients
communication with patients, peers, other health care and significant others involved in care
providers and health care organisations/institutions
Adapt communication style for different patients as
appropriate e.g. for disadvantaged background, cultural
backgrounds
Identify causes of conflict and the principles of

negotiation and resolution, in particular conciliation and
compromise
Work within a team environment
Act as a patient advocate to other health care providers

and/or health care organisations regarding a patient’s
particular cultural concerns such as customs and beliefs
Counsel a person attending a major centre for specialist

consultation for the first time on what to expect
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3. Coordination of Care

Demonstrate a commitment to co-ordination of care Appropriately determine when and how to refer
including:
 referral to other health providers when not able to Understand the various specialist roles and tests they
solely provide optimal care can do to assist in management
 ongoing monitoring
 shared care Identify available community resources both local and
 further strategic interventions where necessary distant and explain how to access them
Assist the patient to navigate through the sea of

bureaucracy
Outline the economics of the administration of a

rehabilitation program
Work in close collaboration with other health

professionals, community based organisations and
support groups in rehabilitating a patient
4. Assessment and Evaluation

Demonstrate competence determining the functional Assess ‘activities of daily living’ (ADLs)
capacities and rehabilitative needs of patients
Assess level of functioning, assistance required and
limiting factors
Elicit a patient history including:

 chief complaint
 present illness
 functional history
 aids used
 past medical history
 review of systems
 psychological profile
 social and cultural aspects
 carers involved
 agencies involved
 education, training, work and finance history
Perform a clinical evaluation particularly from a functional

perspective
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Undertake cognitive evaluation including:

 language and speech
 reading ability
 listening comprehension
 communication capability
 memory
 concentration
 emotional state
5. Treatment

Institute a therapeutic process designed to: Formulate a comprehensive treatment plan
 restore with minimum delay optimum physical,
psychological, social and vocational function of the Possess a general knowledge of and basic skills in
patient rehabilitation treatment with a focus on local needs
 prevent secondary complications of disability including:
 patient conducted techniques including:
Demonstrate a broad understanding of current evidence-  general exercise
based mainstream and alternative rehabilitative  aerobic
treatments commonly used in Australia  anaerobic
 cardiovascular and respiratory fitness
 nutrition
 understanding of cultural variables, access,
affordability, availability etc
 specific exercises and stretches, post isometric
exercises, allied to breathing techniques
 correct posture
 application of cold and heat
 relaxation and meditation techniques
 relevant lifestyle interventions including weight
loss, stress reduction, recreational substance
reduction and sleep improvement
 orthotics and prosthetics
 therapist conducted techniques including:
 thermal therapy
 hydrotherapy
 massage
 biofeedback
 joint mobilisation
 joint manipulation
Guide patients in a comprehensive approach to recovery

including:
 specific therapy including surgery
 psychological support
 self directed activities
 motivation
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 a supportive environment
 general health initiatives
Identify factors relating to the therapist, the patient and

his or her environment liable to impede recovery
Identify the relative efficacy, uses, side effects and

potential abuses of pharmaceutical agents commonly
used in rehabilitation
Assess functionality of the living area and recommend

appropriate modifications (e.g. wheelchair access)
Evaluate the cost and indication for relevant imaging

techniques
Recognise different gait styles and how to classify them
Discuss causes of pathological gait including:

Competently perform a gait analysis  structural
 joint and soft tissue issues
 neurological disorders
Identify appropriate aids to assist
6. Rehabilitative Issues in Specific Age Groups
6.1 Children and Adolescents

Demonstrate competence in the rehabilitation Possess a good working knowledge of paediatrics
management of children and adolescents including:
 physical
 developmental
 emotional development
Recognise the role of family dynamics in the

management of any health problem including:
 co-operation
 guilt
 cultural issues etc
Identify community resources and how to access them
6.2 Aged
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Demonstrate competence in rehabilitation management Discuss the implications of an ageing society on health,
of the aged community and rehabilitation medicine
Note: See also Aged Care Curriculum Statement Interpret and apply legislative, regulatory and medico-
legal aspects of rehabilitative medicine including:
 Palliative Care Act
 enduring medical power of attorney
 vehicle licence regulations
Recognise the specific needs of the aged within the

society and culture they live in
Describe the biological process of ageing and the

implications of loss of organ functionality
Discuss poly-pharmacology issues
Manage conditions that particularly affect the aged

including:
 incontinence
 dementia
 impaired mobility
 poor vision and hearing
Outline primary health care responsibilities including:

 nutrition
 social interaction
 monitor alarms
 fall prevention
Discuss the role of the geriatrician and allied health

members in relation to rehabilitation management
7. Specific Clinical Conditions
7.1 Stroke

Demonstrate competence in rehabilitation of patients Describe relevant anatomy and physiology
suffering from a stroke
Explain the causation and epidemiology of stroke
Classify types of stroke and their potential outcomes

within the context of low to high level rehabilitation
intervention
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Explain current evidence based primary, secondary and

tertiary health care initiatives for stroke
Manage post-stroke complications including:

 function
 cognition
 depression
 Activities of Daily Living (ADLs)
7.2 Traumatic Brain Injury

Demonstrate an understanding of the processes involved Describe relevant anatomy and physiology
in the rehabilitation of patients with traumatic brain injury
(TBI) Dxplain the causation and epidemiology of TBI
Outline the potential effects of TBI on awareness,

cognition, emotion, physical state and behaviour
Explain how early emergency management can

influence outcomes
Outline the doctors role in primary health care measures

aimed at prevention of TBI
In collaboration with other providers, provide post-acute

TBI care, recognising potential social implications (e.g.
epilepsy)
7.3 Spinal Injury

Demonstrate competence in the rural doctors's role in Describe factors involved in the causation, epidemiology
the rehabilitation of patients with a spinal injury and primary health care interventions
Explain relevant anatomy and physiology
Identify types of spinal cord injury and associated

injuries/medical conditions
Perform an examination using the international code
Manage medical emergencies such as autonomic

dysreflexia, acute cauda equina compression
Identify the social issues that may be faced by patients
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with a spinal cord injury
Provide patients support with functional and physical

needs
7.4 Amputation

Demonstrate competence in the rural doctors role in the Describe relevant anatomy and physiology
rehabilitation of amputees
Outline the risk factors for amputation
Outline primary health care initiatives targeting the

prevention of traumatic and non traumatic causes of
amputation
Demonstrate a general understanding of prosthesis and

stump care
Assess cardio respiratory function of a lower limb

amputee to determine whether a wheel chair is indicated
Recognise the influence of other medical conditions on

the function of the amputee
7.5 Orthopaedic

Demonstrate competence in the rehabilitation of patients Understand and implement processes necessary to
orthopaedic conditions maintain and improve function during and following
treatment of injury
Describe relevant anatomy, physiology and

characteristics of ageing bones
Outline measures aimed at reducing falls and their

impact for injury
Identify mobility aids available and home modifications
7.6 Cardiac Disease

Demonstrate competence in rehabilitation of patients Describe relevant anatomy and physiology
with cardiac disease
Identify factors involved in the causation and
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epidemiology of cardiac disease
Describe primary health care measures that are

culturally appropriate
Outline the principles of rehabilitation in cardiac disease,

especially post-myocardial infarction, including:
 exercise
 diet
 lifestyle
 medications
Outline the role of pharmacology in treating acute pain:

 the place or otherwise of narcotics
 other medications
7.7 Pain

Demonstrate competence in the rehabilitation of patients Describe relevant anatomy and physiology
with chronic pain
Explain pain concepts and terms used
Distinguish between acute and chronic pain
Distinguish between musculoskeletal and malignancy

associated pain (tic)
Undertake relevant investigations to assess symptoms

 pain assessment units scales
Outline the various modes of pain treatment and their

appropriate applications including the advantages and
disadvantages of opioid analgesics
Recognise abnormal illness behaviours
7.8 Chronic Degenerative Conditions

Demonstrate competence in the rehabilitation of patients Describe the anatomy and physiology of arthritis and
with chronic degenerative conditions other common conditions
Note: See also Musculoskeletal Curriculum Statement Perform/arrange appropriate investigations and identify
their indications
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Determine appropriate management plans
Outline treatment options
7.9 Skin Conditions

Demonstrate competence in the rehabilitation of patients Explain the factors involved in causation including:
with skin conditions  pressure
 trauma
 burns or scalds
 scars
 keloids
Describe the management of pressure areas, and their

prevention
Provide wound care
Identify cultural justice practices involving punishment

causing wounds
Provide counselling in patients adversely affected by

disfigurement
7.10 Neurogenic Bowel and Bladder Disorders

Demonstrate competence in the rehabilitation of patients Describe relevant anatomy and physiology and factors
with neurogenic bowel and bladder conditions involved in the causation of dysfunction
Perform/arrange appropriate investigations and identify

their indications
Outline the role of specialist opinion, assistance and co-

management
Determine a management plan using pharmacological

and non-pharmacological methods as appropriate
Appropriately utilise community resources such as

continence and stoma ‘therapists’ services
7.11 Sexuality
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Demonstrate competence in the rehabilitation of patients Describe relevant physiology and anatomy
with issues relating to sexuality
Identify relevant issues relating to cultural and religious
beliefs
Take a patient history and conduct a pertinent and

culturally acceptable examination that is adequate
Counsel and advise patients experiencing sexual

problems and dysfunction tic
Identify drugs that influence sexuality
Provide counselling when needed
Identify available community support resources
7.12 Cancer and Other Life Threatening Conditions

Demonstrate competence in the rehabilitation of patients Work in collaboration with other units and providers as
with cancer and other life-threatening conditions an integral member of the oncology team providing
patient care
Provide counselling
Help patients and significant others deal with mortality

issues
Help patients and significant others deal with

disfigurement and provide information on the various
appliances/prosthesis available
6.19.5 Useful Texts

1. DeLisa JA et al . Rehabilitation Medicine Principles and Practice. JB Lippincott Company.
2. Kotte et al. Krusen's Handbook of Physical Medicine and Rehabilitation. Saunders.
3. Corrigan B and Maitland G D Practical Orthopaedic Medicine – Vols I and II Vertebral and Appendicular
Butterworths (Current Edition).
4. Brier SR. Primary Care Orthopaedics Mosby Inc.
5. Grundy D and Swain A . ABC of Spinal Cord Injury . BMJ.
6. Magee. Orthopaedic Physical Assessment . WB Saunders Company.
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6.19.6 Endorsement
This curriculum statement has been endorsed by the Royal Australian College of Physicians
Working Party
Dr David Squirrell (writer)
Dr Nagi Guirguis
Dr Mike Moynihan
Dr Pat Giddings

Dr Peter Baker
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Section Two
6.20 RESEARCH AND EVIDENCE BASED MEDICINE
6.20.1 Context
Medical school studies in Epidemiology/Biostatistics

Participation in clinical audit/development of a community profile/ Evidence Based Medicine literature review.

Information Technology, Population Health
6.20.2 Background
There are many definitions of research. Perhaps the simplest is that: “research is a process of answering specific
questions in a systematic way”. Research should be aimed at finding solutions to problems and finding evidence on
which to base quality practice. Every day clinical practice raises many questions some of which have no ready
answers in the available literature. Each such question may be the genesis of a new research project. In this sense
research is integral to rural and remote general practice as in other fields of medicine.
The practice of Evidence Based Medicine allows practitioners to keep abreast with the rapidly growing body of
medical research literature. It calls for doctors to address clinical issues by reference to the best available clinical
evidence derived from systematic research1. It is a process through which practitioners use relevant, valid
information integrated with professional expertise to make decisions regarding the care of a patient. It consists of five
steps: formulating answerable questions, seeking the best evidence to answer these questions, critically appraising
that information, integrating the appraisal with professional expertise and applying the results to clinical practice and
evaluation of performance2.
The knowledge and skills outlined in this curriculum statement represent essential qualities required of rural and
remote general practitioners in everyday practice. An understanding of research, and skills in the practice of evidence
based medicine enable practitioners to readily adapt to change and maintain a high standard of practice throughout
their career.
1 General Medical Council. Education Committee Report. London, GMC, 1994.
2 Straus SE, Sackett DL. Using research findings in clinical practice. BMJ 1998; 317:339-342.

The registrar will:
 understand the nature and scope of research in rural and remote general practice
 demonstrate the ability to access appropriate and current sources of information in response to clinically
generated research questions
 demonstrate the ability to critically appraise of relevant literature and other research evidence
 understand the main concepts and methods of epidemiological research, and
 recognise and accept that research in rural/remote practice is valuable and achievable.
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Section Two
1. Nature of Research in Rural and Remote General 4. Basic Concepts in Clinical Epidemiology
Practice
2. Accessing the Medical Literature and Other Sources 5. Clinical Audit
of Information
3. Critical Appraisal of Information
6.20.5 Content
1. Nature of Research in Rural and Remote General Practice

Provide an overview of what constitutes research in rural Provide a definition of research
and remote general practice
Know of key (milestone) research undertaken on rural
and remote medicine and rural health issues:
 appreciate what use this research has served
 appreciate how such research findings can influence
government policy and medical training
Gain a basic understanding of nature and scope of

current research activities pertaining to rural and remote
general practice:
 context of rural health and rural practice, e.g:
 psychology and sociology of rural communities
 health status of local population
 rural health services, e.g:
 structure and function
 equity of access to health care
 comparative studies of urban versus
rural/remote health issues
 services for special needs groups
 issues in rural practice eg:
 workforce
 education/training
 recruitment and retention
 quality assurance/quality improvement
 specific clinical/epidemiological problems eg:
 individual diseases
 multi-system diseases
 co-morbidity
 youth suicide
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 lifestyle related illnesses
2. Accessing the Medical Literature and Other Sources of Information

Access appropriate and current sources of information in Undertake a literature search of relevant medical
response to clinically generated research questions information sources, including online databases and CD-
Rom databases
Be able to access sources of evidence based medicine

reviews such as the Cochrane Collaboration
Obtain other relevant sources of information, including:

 legislation
 government reports and statistics
 expert opinion
3. Critical Appraisal of Information

Critically appraise (using an evidence based approach) Outline the principles for evaluating different types of
scientific literature and other relevant information to research literature including:
assist in decision making relating to patient management  original research articles
 randomised control trials
 cohort studies
 case control studies
 review articles
 meta-analysis reviews
 clinical practice guidelines
Demonstrate a basic understanding of the main concepts

and methods of epidemiology and other research
methods
Demonstrate a basic understanding of statistical

techniques used for description and interpretation of
research and evaluation results
Demonstrate an understanding of the range of ethical

issues that arise in conducting research and the key
factors for best practice in research ethics
Evaluate the various components of a piece of literature

according to the following criteria:
 introduction
 validity of research question
 relevance and adequacy of literature review
 methods
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 appropriateness of sample
 appropriate study type
 familiarity with commonly used statistical tests
 measurement of validity and reliability
 results
 completeness
 consistency
 analysis
 appropriate methods
 sufficient analysis
 statistically significant versus clinically
significant
 discussion/conclusions
 consistency with findings
 valid
 clinically relevant
 determine applicability of research findings to the
management of patient presentations in practice
based on appraisal
 communicate effectively the results of relevant
research to patients in terms that can be easily
understood
4. Basic Concepts in Clinical Epidemiology

Demonstrate an understanding of the main concepts and Distinguish between screening and diagnosis
methods of clinical epidemiology, in particular relating to
screening and diagnostic tests Recognise the appropriate use for a test and decide
upon a test’s usefulness
Interpret data according to the characteristics of the test

such as:
 relative risk
 attributable risk
 odds ratio
 incidence
 prevalence
 test sensitivity and specificity
 positive and negative predictive value
5. Clinical Audit

Demonstrate the ability to conduct a clinical audit Outline the differences between clinical audit and
pertaining to an area of one’s own practice as a part of research
implementing a continuous quality improvement process
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Recognise the role of clinical audit in the continuous

quality improvement of a rural/remote medical practice
Carry out a clinical audit including the following

processes:
 needs assessment
 identify standards (e.g. evidence based guidelines)
 data collection/analysis
 identify/implement change
 monitor progress
Demonstrate familiarity with current best practice

approaches to clinical audit processes
Understand and manage patient privacy issues relating

to clinical audit data storage and communication
Working Party
Dr Pat Giddings
Professor David Wilkinson
Dr Brian Murphy
Ms Anna Nichols
Dr Kenneth Lim
Dr John Wakerman
Ms Sue Lenthall
Professor John Humphreys

Professor Leon Piterman
Dr Eric Colquhoun
Professor David Prideaux
Mr Christopher Cutts
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Section Two
6.21 STRATEGIC SKILLS IN RURAL MEDICAL PRACTICE
6.21 STRATEGIC SKILLS IN RURAL AND REMOTE GENERAL PRACTICE
6.21.1 Context
One year of general hospital experience

General Practice and Rural Hospital Post

Population Health, Sociology of Rural and Remote Communities, Rural/Remote General Practice, Research,
Psychiatry
6.21.2 Background
This curriculum statement supports the objective of the ACRRM Postgraduate Training in Rural and Remote
Medicine program to ensure that graduates will be able to demonstrate personal and professional attitudes and
behaviour required for practice in, and membership of, rural and remote communities in Australia
The unit is developed to enhance the skills of women and men to work cooperatively with colleagues, patients, and
the community.
Completion of the unit will provide a framework within which to understand how women and men work in medicine,
and how the work of women can be supported and valued in the context of a discipline and geographic environment
where the experience of women is not well represented.
Doctors who complete the unit will be equipped to provide leadership in their practice, their profession and their
community.
6.21.3 Aim
To increase the skills of rural doctors in identifying and implementing strategies to enhance their ability to practice
medicine in rural and remote locations in ways which reflect their values, skills and multiple roles as women and men.

The registrar will:
 demonstrate the ability to improve clinical practice through use of the evidence base for the impact of gender on
medicine,
 be familiar with the evidence for the interaction between gender and medicine for doctors, patients and
communities, and
 demonstrate the skills necessary to negotiate a sustainable and satisfying professional practice and personal
life.
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Core content: Optional units:

1. Sustainable Rural Practice 5. Support
2. Issues in Clinical Care 6. Management
3. Representation 7. Research
4. Leadership 8. Theory of Gender and Medicine
6.21.6 Content
acquired, while ‘Required Abilities and Skills’describe and define the specific abilities and skills involved and give
1. Sustainable Rural Practice

Demonstrate an ability to structure sustainable rural Be able to resolve role conflict between personal and
practice for female and male doctors professional identities (e.g. caring for family, self and
community)
Be skilled in articulating the different experiences women

and men have as doctors
Be skilled in caring for self and colleagues
Manage the economic consequences of practice styles

preferred by men and women
Understand differential presentations by patients

reflecting the sex and personal style of the doctor
Implement strategies for ensuring personal safety in rural

practice
2. Issues in Clinical Care

Demonstrate an ability to analyse and articulate gender Understand issues relating to gender bias in research
issues in clinical care and clinical care
Appreciate that normal values and treatment regimes are

often based on research on males
Understand issues relating to the biopsychosocial and
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cultural construction of gender for doctor and patient
Be aware of communication skills appropriate to each

sex
Define the different cultural expectations of women, both

between cultures, and between women and men in
Australian culture
Understand the implications for the health of women and

men
3. Representation

Demonstrate competency to achieve equal Know of the evidence of the under-representation of
representation of women and men in medicine women in decision-making roles
Diagnose some of the reasons for this
Understand the importance of non-dominant groups

speaking for themselves
Define strategies used to silence members of these

groups
Experience in ensuring non-dominant groups are

included in decision-making bodies
4. Leadership

Demonstrate leadership Understand some of the criteria for leadership
Be able to establish the necessary conditions for

leadership
Be experienced in developing personal strategies for

leadership
Analyse the myth that men are successful because they

are competent, women because they are lucky
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5. Support

Demonstrate an understanding of the support needs of Distinguish between the values of cooperation and
women and men in rural practice and strategies for competition
achieving these
Outline strategies for supporting women and men
Outline professional and personal support needs of men

and women
Develop strategies to deal with women's grief associated

with recognition of loss of value in their profession
because of their femaleness
6. Management

Demonstrate management skills Understand issues in practice management
Understand the differences in women’s and men's

management styles
Be skillled in designing a system to manage the

boundary between professional and personal roles
Recognise when structures work better for one sex than

another
7. Research

Define criteria for gender inclusive research Discuss some of the ways in which topics for research
are selected and excluded
Understand the challenge the women’s health movement

made to medical research and practice
Consider the evidence about gender differences in styles

of thinking and knowing
Provide an assessment of what is not included when one

style is privileged and the other silenced
Understand issues for women and men as researchers
Page 258 of 275

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8. Theory of Gender and Medicine

Demonstrate an ability to articulate an understanding of Understand some of the elements of the construction of
the interaction between gender and medicine knowledge
Demonstrate an understanding of the origins of scientific

medicine
Consider the effects of gender issues on the content of

medicine in its early development
Articulate some elements of the absent curriculum
Understand the impact on the structure of medicine of

the relative paucity of women in its development
Recognise the ways in which the structures and reward

systems of medicine advantage males as compared to
females
Enable men and women to recognise and value their

feminine characteristics
Understand issues relating to sex and gender and

medicine
Understand issues relating to the interaction of gender

and the culture of medicine
Compare teaching/learning styles of women and men
Understand issues relating to socialised gender: females

internalise, males externalise
6.21.7 Teaching and Assessment Methods

Core Content
Sustainable Rural Practice
Teaching methods Assessment

 Online discussion
 Presentation to colleagues OR
 Web or postal delivery of materials
 Written or illustrated assignment
 Teleconferences
Page 259 of 275

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Issues in Clinical Care

 Web search or journal review, 1 journal for 5 years  Analysis of findings
Representation

 Membership of practice management group,  Reflective diary
divisional committee or ACRRM sub-committee  Evidence of one positive change implemented
Leadership

 Reflective exploration of 2 leadership experiences
 Lead a workshop
 Face-to-face weekend workshop – leadership task
 Lead a problem-solving group
 Chair an important meeting
Optional Units
Support

 Participation in email list discussion  Written evaluation of process and outcomes of
 Establish and document a support group for women group OR
in ACRRM, division, practice or community  Article in Ausdoc, Medical Observer or Australian
 Mentor a younger colleague Journal of Rural Health
Management

 Design a gender sensitive roster for clinic/hospital
 Design an equitable financial scheme for your  Negotiate implementation of roster OR
practice  Practice management tasks
 Bi-weekly discussion group by teleconference
Research

 Identify a research topic which is more likely to
occur/be important to a female doctor
 Identify 4 pieces of research where women have not  Develop assessment criteria for research
been included submissions to ensure gender balance
 Discussion of where this comes from, the impact on
medicine as science, and how it could be different
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Section Two
Theory of Gender and Medicine

 Conduct a focus group/tutorial/lunch time meeting
about gender and medicine with medical students
 Reflection on your experience as a medical student,
from your nearest university OR
as a resident and as a registrar
 Conduct a workshop/present a paper on gender and
 Analysis of texts
medicine at your Division meeting AND
 Report on the outcome
6.21.8 Resources
 Professor Amanda Sinclair “Doing Leadership Differently”
 Journal articles
 Belenky et al “Women’s Ways of Knowing”
 ACRRM Prospectus
 Websites
 Tutor
 Tutorial group
 Strategic handbook
 Assoc/Prof Carolyn Quadrio “The Fat Lady Sings”
 Kirner & Rayner “The Women’s Power Handbook”
 AAMC “Increasing Women’s Leadership in Academic Medicine”
 Tolhurst et al “Education and Support Needs of Women in Rural Practice”
 Report on mentoring scheme from Monash University Faculty of Medicine, and RACS
 National Women’s Health Policy
 “A Sliver, not even a Slice”
 NHMRC website
 Wennerds, Christine, & Wold, Agnes (1997). Nepotism and Sexism in Peer Review. Nature 307 (6631), p. 341
(22 May 1997)
 Wertheim, M “Pythagoras Trousers”
 Daly , M. “Gyn/Ecology
Writers/Working Party
Ms Jo Wainer
Dr Lexia Bryant

Dr Louise Baker
Dr Tom Doolan
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6.22 SURGERY
6.22 SURGERY
6.22.1 Context
EMST course (completion or enrolment in)

Postgraduate hospital post in Surgery

Adult Internal Medicine, Anaesthetics, Child & Adolescent Health, Obstetrics

The registrar will:
 demonstrate the necessary knowledge and clinical skills to competently undertake appropriate investigations
and formulate diagnosis of surgical conditions in rural and remote practice
 demonstrate the ability to develop management plans for these conditions including fluid replacement,
analgesia, plus communication skills with senior surgical colleges and a practical understanding of transfer and
evacuation
 demonstrate a working knowledge of EMST principles and have completed that course
 demonstrate a working knowledge of the mechanisms of injury, pathological processes of disease, basic surgical
processes and appropriate stabilisation for management elsewhere
 demonstrate the skills to competently perform a range of common minor surgical procedures under minimal or
distant supervision
 understand the medico-legal implications of performing surgical procedures on a patient, and
activities in the provision of surgical services in rural and remote practice.
1. Minor Surgical Skills 7. Ophthalmological Surgical Conditions

2. Management of the Acute Abdomen 8. Vascular Surgical Conditions
3. Chest Surgery 9. E.N.T. Surgical Conditions
4. Urological Surgical Conditions 10. Orthopaedic Surgical Conditions
5. Colo-Rectal Surgical Conditions 11. Trauma Management
6. Neurosurgery 12. Professional and Ethical Responsibilities
6.22.4 Content
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6.22 SURGERY
1. Minor Surgical Skills

Demonstrate expertise in the diagnosis and treatment of Excise benign and malignant skin lesions including:
benign and malignant skin lesions  lipomata/sebaceous cysts
 sub cutaneous foreign bodies
 perform cryotherapy of skin lesions and demonstrate
an understanding of associated medico-legal
implications
Know the indications and contraindications

Demonstrate skills in performing nail bed resection for
chronic ingrown toenails Perform local anaesthesia and tourniquet procedures
Perform the procedure and provide post operative

management e.g. dressing, bleeding etc
Know the indications
Demonstrate skills in performing an aspiration of a Perform anaesthesia

subungual haematoma
Perform the procedure and provide post operative
management
Know the indications
Demonstrate competence in sterilisation techniques

Demonstrate skills in performing joint aspiration and
injection Undertake appropriate fluid analysis
Make appropriate use of intra-articular steroids
Understand the use of Synvisc
Demonstrate knowledge of the aetiology and

pathogenesis of common skin infections
Describe and recognise symptoms

Demonstrate competence in the diagnosis and treatment Undertake/arrange/interpret appropriate investigations
of common skin infections including:
 impetigo
 cellulitis
 abscesses and boils
 haematomata Determine appropriate management plans:
 outline indications for referral to specialised
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Section Two
6.22 SURGERY
care
with consultation
 further investigations
 undertake conservative measures as
appropriate
 undertake operative measures as appropriate
2. Management of the Acute Abdomen

Demonstrate competence in the initial investigation and Understand the anatomy and physiology of the
management of the acute abdomen gastrointestinal tract
Diagnose:
 appendicitis
 biliary colic
 cholelithiasis cholangitis
 pancreatitis
 oesophagitis/G.U./D.U.
 inflammatory bowel disease
 renal causes
 aortic/vascular aneurysm disease
 diverticulitis/ischaemic colitis
 acute infective diarrhoeal illness
 perforated viscus
 strangulated herniae
Understand the aetiology and pathogenesis of these

conditions
Understand the:
 types of abdominal pain
 onset and progression of pain
 associated factors
Elicit an accurate and detailed patient history
Competently perform a physical examination:

 systemic signs and observations
 inspection
 abdominal palpitation
 rectal examination
 pelvic examination
 auscultation
 percussion
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6.22 SURGERY
Undertake/arrange/interpret appropriate investigations:

 urine dip stick test/microscopy
 faecal test for occult blood/faecal microscopy
 ECG
 blood investigations
 radiology
 endoscopy
 paracentesis/peritoneal lavage
Determine management plan:

care
with consultation
appropriate
Reach an initial diagnosis for:

 tumours of the colon
Demonstrate competence in the initial investigation and  acute urinary retention
management of visceral perforation and peritonitis  non surgical causes of abdominal pain
Demonstrate knowledge of the aetiology and

pathogenesis of these conditions
Elicit a detailed and accurate patient history
Perform a physical examination

with consultation
appropriate
Competently perform the following:

 cannulation
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Section Two
6.22 SURGERY
 intravenous cutdown
Demonstrate competence in performance of relevant  fluid replacement
procedures  electrolyte balance assessment and replacement
 blood gas analysis
 bladder
 transurethral catheterisation
 suprapubic catheterisation
 nasogastric drainage
 appropriate analgesia
3. Chest Surgery

Achieve excellence in interpreting chest x-rays Identify:
 pneumothorax
 upper and lower airway obstruction
 pleural effusion and haemathorax
 pericardial effusion
 perforated oesophagus/Boaerhaver’s
 syndrome
 rib fractures

conditions
Insert an intercostal underwater seal drain

Demonstrate competence in performance of relevant
procedures Perform a pleural tap
Perform a pericardial aspirate
Perform cricothyroidotomy
4. Urological Surgical Conditions

Recognise and appreciate the causes of haematuria: Know the aetiology and pathogenesis of these conditions
 medical
 surgical Understand the types of haematuria and associated
 traumatic causes
Demonstrate competence in the diagnosis and initial Diagnose:

management of renal tract tumours  renal tract calculus
 renal trauma
 urinary tract infections
 torsion of testis
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6.22 SURGERY

conditions
Elicit a detailed and accurate patient history

care
with consultation
appropriate
5. Colo-rectal Surgical Conditions

Demonstrate expertise in the diagnosis and Understand the anatomy and physiology of the ano-
management of ano-rectal disorders rectal mechanism
Diagnose:
 perianal haematoma
 perianal abscess

conditions
Competently perform rigid/flexible sigmoidoscopy
Recognise basic sigmoidoscopic pathologies
Perform thrombosed peri-anal haematoma drainage

Demonstrate competence in performance of relevant
procedures Perform drainage of peri-anal abscess
Undertake appropriate investigations including diagnostic

Demonstrate a working knowledge of neoplasia of the appreciation of colonoscopy and barium enema
colon and rectum
Make appropriate referral
Outline the current National guidelines for colorectal
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6.22 SURGERY
carcinoma screening
6. Neurosurgery

Demonstrate expertise in the recognition and Diagnose:
management of neurosurgical conditions  closed head injury
 acute and chronic subdural haematoma
Understand the importance of localised/generalised  tumours of the CNS
signs  vascular disasters of the CNS
 berri aneurysm
 AVM
 trauma to the spinal cord and peripheral nerves
 intracranial haemorrhage

conditions

care
with consultation
appropriate
including burrholes
7. Ophthalmological Surgical Conditions

Demonstrate expertise in the recognition and Understand normal ocular anatomy
management of ophthalmological surgical conditions
Diagnose:
 sudden loss of vision
 non penetrating ocular trauma
 corneal foreign bodies
 corneal abrasion
 hyphema
 lens dislocation
 retinal detachment
 penetrating eye wounds
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6.22 SURGERY
 eyelid and skin tumours

 trauma
 infections
Demonstrate competence in performance of relevant Competently perform an ocular examination

procedures
Competently test visual acuity and peripheral fields
Perform ophthalmoscopy and slit lamp examination
Anaesthetise and fluorescein stain the cornea
Remove superficial and embedded corneal foreign

bodies
Treat eyelid eversion
Perform a chalazion excision
8. Vascular Surgical Conditions

Demonstrate competence in the recognition and Diagnose:
management of vascular surgical conditions  acute peripheral vascular occlusive
disease/threatened limb
 DVT
 varicose veins
 abdo aortic aneurysm

conditions/diseases

care
with consultation
appropriate
Demonstrate a working knowledge of angioplasty and
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6.22 SURGERY
bypass surgical techniques
Demonstrate a working knowledge of venous ulceration

and deep venous incompetence
9. E.N.T. Surgical Conditions

Demonstrate competence in the recognition and Diagnose:
management of ENT surgical conditions  tympanic perforation
 aural foreign bodies
 otitis externa
 tumours of the ear
 nasal foreign bodies
 nasal polyps and tumours
 sinusitis, maxillary, and other sinuses
 medical nasal conditions
 throat and pharynx conditions
 uvular oedema
 tonsilitis/quinsy
 glottic and pharyngeal foreign bodies
 epiglottitis
Differentiate between anterior and posterior bleeding for

epistaxis
Examine the nares with a nasal spectrum
perform nasal packing, including:

Demonstrate competence in performance of relevant  chemical, electrocautery
procedures
Competently manage and treat epistaxis including
simpsons balloon or the like
Examine ear canals and recognise common and serious

ear disease e.g. cholesteatoma, round window rupture
Undertake hearing assessment including the

interpretation and performance of audiometry and
tympanometry
Syringe the external auditory canal and perform an aural

toilet
Insert ‘wicks’ into the ear canal
Remove foreign bodies from the ear, nose and throat
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6.22 SURGERY
Identify and manage acute and chronic sinusitis,

including sinus lavage and alternative management
protocols
Perform incision and drainage of quinsy
Perform indirect laryngoscopy, and identify laryngeal

conditions
10. Orthopaedic Surgical Conditions

Provide initial diagnosis and emergency treatment for Diagnose the following fractures:
fractures  skull
 cervical spine
 orbit
 zygoma
 face
 jaw
 thoracic and lumbar spine
 clavicle
 ribs
 pelvis
 neck of humerus
 supracondylar humerous
 head of radius
 mid forearm
 distal forearm including Colles, Smiths
 metacarpals especially scaphoid
 digits
 femur, tibia
 Potts fracture
 calcaneus
 metatarsals
Understand crush injuries

 systemic complications (far embolism)
 compartment syndrome
Demonstrate competence in performance of relevant Perform initial reduction of some of the minor fractures
procedures listed depending on experience and certified competence
Understand requisite analgesia and anaesthesia
Be competent in relocation techniques
Supervise post procedure care including mobilisation

and recovery
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6.22 SURGERY
Diagnose:
Provide initial diagnosis and emergency treatment for  jaw (temporomandibular joint)
dislocations  shoulder – anterior/posterior
 patella
 interphalangeal joints
 lunate
 femur
 ankle
Understand requisite analgesia and anaesthesia
Perform relocation techniques
Demonstrate an understanding of dislocation Supervise post procedure care including mobilisation

management and recovery
11. Trauma Management

Demonstrate competence in the initial diagnosis of the Assess injury by physical exam and available
traumatised patient investigations
Demonstrate competence in the assessment of multiple Understand triage principles

trauma patients
Demonstrate competence in the management of trauma Have completed an EMST course
Understand and apply EMST principles
Undertake appropriate communications with senior

colleagues and referral agencies
Arrange appropriate transfer and evacuation
Demonstrate functionality in disaster situations Understand principles of disaster medicine
Know of disaster plans and role of medical officer in

same

Page 272 of 275

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6.22 SURGERY
staff
Demonstrate an ability to recognise one’s own limitations Demonstrate an awareness of local issues which impact
and appropriately determine when to refer on the decision to treat or refer, such as local transport
and evacuation processes
network
Working Party
Dr Henry Hancock (writer)
Dr Jack Shepherd
Dr Tom Doolan
Dr Richard Stiles

Dr Ken Pearson
Dr Tony Lian-Lloyd
Dr Andrew Swanson
Page 273 of 275

Section Two
6.22 SURGERY
References
1. ACRRM, Prospectus. 1997a, Brisbane: Australian College of Rural and Remote Medicine.
2. ACRRM, Primary Curriculum Position Paper. 1997b, Brisbane: Australian College of Rural and Remote Medicine.
3. AIHW, Australia's health 2006. 2006a, Canberra: Aust Institute of Health and Welfare.
4. Strong, K., P. Trickett, I. Titulaer, and K. Bhatia, Health in rural and remote Australia: The first report of the Australian Institute of
Health and Welfare on rural health, Cat No PHE 6. 1998, Australian Institute of Health and Welfare: Canberra.
p. pp. 1-131.
5. Hays, R.B., A. Wallace, and T.K. SenGupta, Training for rural family practice in Australia. Teaching and Learning in Medicine,
1999. 9(2): p. 80-82.
6. Veitch, P., M. Sheehan, J. Holmes, T. Doolan, and A. Wallace, Barriers to the use of urban medical services by rural and remote
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7. ABS, Australian Social trends 2008. Population distribution. ABS
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11. Keleher, H. and J. Ellis, Rural People utilising city hospitals: issues for service provision. Aust J Rural Health, 1996. 4: p.
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Canberra.
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16. ACRRM, AMC Submission. 2004, ACRRM unpub.: Brisbane.
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Adena, The influence of geographical location on the complexity of rural general practice activities. MJA, 2002b. 179(8): p. 416-
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Medical Journal of Australia, 1994. 161: p. 314-318.
19. Britt, H., G. Miller, and L. Valenti, It's different in the bush - A comparison of general practice activity in metropolitan and rural areas
of Australia 1998 - 2000. Cat No GEP 6. 2001, Australian Institute of Health and Welfare: Sydney.
20. DHAC, General Practice in Australia: 2000: First Edition, Dept Helath and Aged Care
http://www.health.gov.au/gpconnections/gpinoz.htm. Retrieved
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2004. 38(3): p. 314-26.

32. Lockyer J, Blackmore D, Fidler H, Crutcher R, Salte B, Shaw K, Ward B, and N. Wolfish, A study of a multi-source feedback system
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Page 275 of 275

Section Two

ACRRM Primary Curriculum 3rd Edition 25-09-09 With Cover

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Third Edition

Level 4, 410 Queen Street

Telephone 07 3105 8200 Email acrrm@acrrm.org.au

1.1 Defining Rural and Remote Medicine

1.2 Target Group

1.4 Rationale – Why is Rural and Medicine Important?

Services and Workforce

Quality and Safety

Scope of Rural and Remote Medicine

2.3 Curriculum Framework

The following 11 principles underpin this Primary Curriculum:

9. Utilisation of information technology – Curriculum implementation is based on a robust and innovative

2.5 Learning outcomes

The domains are:

1. Core clinical knowledge and skills

2.5.1 Domain 1 – Core Clinical Knowledge and Skills

This domain includes:

The assessable learning outcomes for this domain are:

107 Consider uncommon but clinically important differential diagnoses

108 Apply core procedural skills in clinical practice

114 Use the principles of universal precautions against infection in practice

2.5.2 Domain 2 – Extended Clinical Practice

This domain includes:

The assessable learning outcomes for this domain are:

203 Provide secondary and tertiary based care as required

207 Demonstrate the ability to undertake the relevant forensic responsibilities

2.5.3 Domain 3 – Emergency Care

This domain includes:

The assessable learning outcomes for this domain are:

304 Perform required emergency procedures and courses

307 Communicate effectively at a distance with consulting or receiving clinical personnel

2.5.4 Domain 4 – Population Health

This domain includes:

The assessable learning outcomes for this domain are:

403.1 Undertake, supervise and monitor early detection strategies

403.2 Use brief interventions in managing chronic disease

403.4 Provide health education and health promotion strategies in practice

405 Evaluate the quality of health care for practice populations

2.5.5 Domain 5 – Aboriginal and Torres Strait Islander Health

This domain includes:

The assessable learning outcomes for this domain are:

2.5.6 Domain 6 – Professional, Legal and Ethical Practice

This domain includes:

The assessable learning outcomes for this domain are:

603 Engage in education of other medical and health professionals

606 Maintain confidentiality in small communities

607 Maintain professional and social boundaries

608 Use and undertake relevant research to inform practice

614 Apply professional, ethical, and legal guidelines to their practice

2.5.7 Domain 7 – Rural and Remote Context

This domain includes:

The assessable learning outcomes for this domain are:

702.1 Respond to community needs

2.6 Curriculum Statements

The disciplines covered by the 22 curriculum statements are:

1. Aboriginal and Torres Strait Islander Health

3.1 ACRRM Training Standards

ACRRM’s training standards define:

These standards include:

3.2 ACRRM Training Pathways

1. Vocational Preparation Pathway

3.3 Duration of Training

Training is comprised of: