During advanced training, it is intended that the trainee shall develop the following knowledge and skills.

Medical Knowledge

This is the up-to-date body of knowledge and information required to manage patients. It incorporates the synthesis and application of this information to clinical problems.

Medical knowledge is continually changing. Physicians are required to keep abreast of these changes and to develop the ability to derive relevant evidence-based information and apply it to patient management.

In order to gather knowledge efficiently the development of skills in the area of medical informatics is required. An understanding of the use and limitations of the expanding field of telemedicine is valuable.

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Clinical Skills

These are the basic tools of a physician. They include the skills necessary to:

• take organised, relevant and complete medical histories;
• perform thorough physical examinations;
• use diagnostic studies and technical procedures appropriately, including understanding the indications, performing the studies and procedures and interpreting the results.

Clinical skills are developed and assessed during advanced training. At the end of advanced training, the trainee will possess the skills required to practise competently in the chosen area of adult internal medicine.

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Clinical Judgement

This is the process by which diagnostic and therapeutic decisions are made. It requires:

• integration of medical knowledge and clinical skills;
• consideration of diagnostic and therapeutic alternatives; and
• understanding of the limitations of one's knowledge and experience.

The ability to understand scientific and technological developments in medicine and to apply these appropriately to patient care is also a feature of good clinical judgement. Knowledge of community resources and an understanding of the principles of preventive care are important.

Good clinical judgement includes consideration of the risk-benefit ratio for the patient of the available management options.

Furthermore, clinical judgement must be tempered by an appreciation of the finite nature of health expenditure, including an awareness of the cost of investigations and treatment, and other basic issues of health economics.

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Understanding of Research Methodology and Quality Assurance

A basic knowledge of research methodology, including hypothesis generation and testing and the principles of statistical analysis is essential for a physician.

In all areas of practice, an understanding of the principles of clinical epidemiology is important.

In keeping with trends in continuing education, the trainee will learn how to initiate and evaluate quality assurance programs.
Trainees should be familiar with the basic principles of the RACP Maintenance of Professional Standards program.

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Humanistic Qualities

The consistent demonstration of integrity, respect and compassion is required in the care of patients and their families. These qualities include the ability to:

• listen, be honest, courteous and responsive to the patient's wishes;
• be respectful of the patient's need for information and autonomy;
• earn the patient's trust;
• provide empathy; and
• maintain credibility and rapport with the patient and the patient's family.

A sympathetic understanding of the interaction between health needs and socio-economic factors, is necessary.

Of equal importance is an appreciation of the issues surrounding indigenous health matters.

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Moral and Ethical Behaviour

This implies consistent demonstration of high standards of moral and ethical behaviour towards patients, families and co-workers.

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Professional Attitude and Behaviour

These are the attitudes, behaviour and interpersonal skills defined as essential in relating to and educating patients, their families and other health care professionals. They include the ability and willingness to:

• accept responsibility;
• communicate effectively;
• maintain comprehensive, timely medical records;
• be available in a consultative role to other physicians when needed; and
• evaluate new medical scientific information relevant to the practice of medicine.

Skills and experience in self-assessment and systematic peer review of quality of care are also expected.

A wise physician recognises when fatigue or illness is likely to impair clinical competence and seeks colleagues' help for patient and self at these times.

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Total Medical Care

The ability to manage patients effectively requires integration of the above skills. Excellent medical care results from the consistent ability to:

• apply appropriate comprehensive care of high quality;
• be responsive to the patient's needs and wishes;
• use therapeutic modalities, laboratory tests and diagnostic procedures efficiently and in the patient's best interest;
• provide appropriate and efficient utilization and coordination of care by consultants and allied health care professionals; and
• ensure patient advocacy for optimal use of limited resources to maintain or enhance quality of care.

In order to deliver efficient total care in an ongoing fashion, the physician must develop skills in practice management. These include an understanding of the economics of running a practice as well as of the legislative and statutory requirements of a practicing physician.

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