Entrustable Professional Activities (EPAs) are important work tasks that trainees need to be able to perform with supervision at a distance by the end of Basic Training.
By the end of Basic Training trainees need to be able to perform each EPA with supervision at a distance.
Each of the EPAs:
- is an exemplar, discrete task, separable from other tasks, which relates to patient care
- can be readily observed and assessed
- relates to safe healthcare in the workplace. There are consequences associated to this task that are not easily reversed.
Entrustable Professional Activities for Basic Trainees in Adult Internal Medicine and Paediatrics & Child Health (PDF 1.1MB)
EPA Behaviours
Each EPA includes the behaviours of a trainee who can perform the task with supervision at a distance and examples of behaviours of a trainee who is not yet ready to perform the task with supervision at a distance. The behaviours are categorised according to the domains of the RACP Professional Practice Framework, however each EPA should be performed and assessed as a complete task.
How to browse related content
Some parts of the curriculum standards relate to content in other curriculum standards. For example, in the Medical Expertise behaviours you can access links to related Competency content. View the related content within each of the following domains by clicking the '+' symbol.
EPA 6 - Investigations
Choose, organise, and interpret investigations
This activity requires the ability to:
- plan, rationalise, and arrange investigations
- discuss investigative plans with patients, their families, or carers, and support them to make informed choices
- follow-up the results of investigations and interpret the results independently
- follow-up investigations that have been ordered but not performed
- communicate results of investigations with patients
- modify management plans based on new information
- perform this activity in multiple settings, including inpatient and ambulatory care settings and in emergency departments.
Behaviours
Each EPA has lists of behaviours. The behaviours help trainees understand how they can improve, and help supervisors to make decisions about whether trainees can be trusted to do the task with supervision at a distance
Medical expertise
Ready to perform with supervision at a distance
Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.
The trainee:
- plans appropriate investigations based on clinical assessment
- provides rationales for investigations
- understands the significance of abnormal test results and acts on these as appropriate and in a timely manner
- modifies patients’ management plans based on the results of investigations in a timely manner
- estimates pre-test probability and applies this concept appropriately when ordering investigations
- considers patient factors and comorbidities
- considers age-specific reference ranges
- understands the implications of genetic testing for patients and families
Not yet ready to perform with supervision at a distance
Examples of behaviours of a trainee not yet ready to perform this activity with supervision at a distance.
The trainee may:
- demonstrate a lack of awareness of the significance of abnormal test results and the appropriate response
- inadequately modify management plans when results of investigations would indicate that a change in management is appropriate
- order or intend to order inappropriate investigations
Related competency themes
Communication
Ready to perform with supervision at a distance
Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.
The trainee:
- discusses the indications, risks, benefits, and complications of investigations with patients prior to ordering the investigation, in order to obtain informed consent and conduct investigation
- communicates and explains the results of investigations to patients
Not yet ready to perform with supervision at a distance
Examples of behaviours of a trainee not yet ready to perform this activity with supervision at a distance.
The trainee may:
- have difficulty in clearly explaining investigations to patients, such as excessive use of medical jargon
- inadequately complete required documentation or investigation request forms
- provide inadequate information on referrals for investigations or inadequately convey the indication for ordering particular tests
- have difficulty communicating clearly with other services regarding timing or prioritisation of investigations
- inadequately communicate significant results to appropriate health professionals
- inadequately explain the implication of results to patients
Related competency themes
Quality and safety
Ready to perform with supervision at a distance
Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.
The trainee:
- seeks help with interpretation of test results for less common tests or indications, or unexpected results
- considers safety aspects of investigations when planning to order them, such as radiation exposure, taking large volumes of blood from small infants, or sedation required to perform the investigation
Not yet ready to perform with supervision at a distance
Examples of behaviours of a trainee not yet ready to perform this activity with supervision at a distance.
The trainee may:
- order potentially dangerous investigations, such as CT scan of a pregnant patient or MRI in a patient with a pacemaker
Related competency themes
Teaching and learning
Ready to perform with supervision at a distance
Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.
The trainee:
- undertakes continuing professional development to maintain currency with investigation guidelines
Related competency themes
Research
Ready to perform with supervision at a distance
Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.
The trainee:
- consults current research on investigations
- refer to evidence-based clinical guidelines
- demonstrates understanding of the limitations of evidence and the challenges of applying research in daily practice
Related competency themes
Cultural competence
Ready to perform with supervision at a distance
Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.
The trainee:
- appreciates patients’ cultural and religious backgrounds, attitudes, and beliefs, and how these might influence the acceptability of proposed investigations
Related competency themes
Ethics and professional behaviour
Ready to perform with supervision at a distance
Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.
The trainee:
- consistently involves patients in decision-making regarding investigations, and obtains the appropriate informed consent, including financial consent if necessary
- identifies appropriate proxy decision makers when required
- chooses not to investigate in situations where it is not appropriate to investigate for ethical reasons
Not yet ready to perform with supervision at a distance
Examples of behaviours of a trainee not yet ready to perform this activity with supervision at a distance.
The trainee may:
- inadequately follow-up on results of investigations or not handover to colleagues to review investigations
Related competency themes
Judgement and decision making
Ready to perform with supervision at a distance
Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.
The trainee:
- chooses the most appropriate investigation for the clinical scenario in discussion with patients
- minimises the number of investigations for effective clinical care
- adjusts the investigative path depending on the test results received
- evaluates the costs, benefits, and potential risks of each investigation in a clinical situation
- recognises their own limitations and seeks help when required in an appropriate way
Not yet ready to perform with supervision at a distance
Examples of behaviours of a trainee not yet ready to perform this activity with supervision at a distance.
The trainee may:
- have difficulty deciding on appropriate investigations
- under- or over-investigate
- inadequately consult with senior colleagues
Related competency themes
Leadership, management and teamwork
Ready to perform with supervision at a distance
Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.
The trainee:
- takes responsibility for following up on results and ensures results are checked in a timely manner, or provides appropriate and thorough handover to other staff to do so
Related competency themes
Health policy, systems and advocacy
Ready to perform with supervision at a distance
Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.
The trainee:
- arranges investigations efficiently, including providing an accurate, informative referral, liaising with other services where appropriate, and advocating on behalf of patients
- factors the costs to patients and the community into decisions to order investigations
Not yet ready to perform with supervision at a distance
Examples of behaviours of a trainee not yet ready to perform this activity with supervision at a distance.
The trainee may:
- order investigations injudiciously and be unaware of the impact at a health system level
Related competency themes
Related Knowledge Guide
Adult Medicine
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Cardiology - Key presentations and conditions
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Cardiology - Less common or more complex presentations and conditions
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Cardiology - Investigations, procedures and clinical assessment tools
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Dermatology - Key presentations and conditions
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Dermatology - Less common or more complex presentations and conditions
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Dermatology - Investigations, procedures and clinical assessment tools
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Dermatology - Important specific issues
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Endocrinology - Key presentation and conditions
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Endocrinology - Less common or more complex presentation and conditions
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Endocrinology - Investigations, procedures and clinical assessment tools
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Endocrinology - Important specific issues
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Gastroenterology - Key presentations and conditions
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Gastroenterology - Less common or more complex presentations and conditions
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Gastroenterology - Investigations, procedures and clinical assessment tools
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Gastroenterology - Important specific issues
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General Medicine - Key presentations and conditions
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General Medicine - Less common or more complex presentations and conditions
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General Medicine - Investigations, procedures and clinical assessment tools
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General Medicine - Important specific issues
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Genetic and Metabolic Medicine - Key presentations and conditions
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Genetic and Metabolic Medicine - Less common or more complex presentations and conditions
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Genetic and Metabolic Medicine - Investigations, procedures and clinical assessment tools
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Genetic and Metabolic Medicine - Important specific issues
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Geriatric Medicine - Key presentations and conditions
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Geriatric Medicine - Less common or more complex presentations and conditions
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Geriatric Medicine - Investigations, procedures and clinical assessment tools
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Geriatric Medicine - Important specific issues
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Haematology - Key presentations and conditions
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Haematology - Less common or more complex presentations and conditions
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Haematology - Investigations, procedures and clinical assessment tools
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Immunology & Allergy - Key presentations and conditions
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Immunology & Allergy - Less common or more complex presentations and conditions
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Immunology & Allergy - Investigations, procedures and clinical assessment tools
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Infectious Diseases - Key presentations and conditions
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Infectious Diseases - Less common or more complex presentations and conditions
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Infectious Diseases - Investigations, procedures and clinical assessment tools
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Infectious Diseases - Important specific issues
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Medical Obstetrics - Key presentations and conditions
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Medical Obstetrics - Less common or more complex presentations or conditions
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Medical Obstetrics - Investigations, procedures and clinical assessment tools
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Medical Obstetrics - Important specific issues
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Medical Oncology - Key presentations and conditions
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Medical Oncology - Less common or more complex presentations and conditions
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Medical Oncology - Investigations, procedures and clinical assessment tools
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Nephrology - Key presentations and conditions
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Nephrology - Less common or more complex presentations and conditions
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Nephrology - Investigations, procedures and clinical assessment tools
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Neurology - Key presentations and conditions
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Neurology - Less common or more complex presentations and conditions
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Neurology - Investigations, procedures and clinical assessment tools
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Palliative Medicine - Key presentations and conditions
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Palliative Medicine - Less common or more complex presentations and conditions
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Palliative Medicine - Investigations, procedures and clinical assessment tools
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Pharmacology, Toxicology and Addiction Medicine - Key presentations and conditions
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Pharmacology, Toxicology and Addiction Medicine - Less common or more complex presentations and conditions
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Respiratory and Sleep Medicine - Key presentations and conditions
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Respiratory and Sleep Medicine - Less common or more complex presentations and conditions
-
Respiratory and Sleep Medicine - Investigations, procedures and clinical assessment tools
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Rheumatology - Key presentations and conditions
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Rheumatology - Less common or more complex presentations and conditions
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Rheumatology - Investigations, procedures and clinical assessment tools
Paediatrics & Child Health
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Adolescent and Young Adult Medicine - Key presentations and conditions
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Adolescent and Young Adult Medicine - Less common or more complex presentations and conditions
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Adolescent and Young Adult Medicine - Investigations, procedures and clinical assessment tools
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Cardiology - Key presentations and conditions
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Cardiology - Less common or more complex presentations and conditions
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Cardiology - Investigations, procedures and clinical assessment tools
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Clinical Sciences - Investigations, procedures and clinical assessment tools
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Dermatology - Key presentations and conditions
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Dermatology - Less common or more complex presentations and conditions
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Dermatology - Investigations, procedures and clinical assessment tools
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Emergency Medicine - Key presentations and conditions
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Emergency Medicine - Less common or more complex presentations and conditions
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Emergency Medicine - Investigations, procedures and clinical assessment tools
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Endocrinology - Key presentations and conditions
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Endocrinology - Less common or more complex presentations and conditions
-
Endocrinology - Investigations, procedures and clinical assessment tools
-
Endocrinology - Important specific issues
-
Gastroenterology - Key presentations and conditions
-
Gastroenterology - Less common and more complex presentations and conditions
-
Gastroenterology - Investigations, procedures and clinical assessment tools
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Gastroenterology - Important specific issues
-
General and Community Paediatrics - Key presentations and conditions
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General and Community Paediatrics - Less common or more complex presentations and conditions
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General and Community Paediatrics - Investigations, procedures and clinical assessment tools
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Genetic and Metabolic Medicine - Key presentations and conditions
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Genetic and Metabolic Medicine - Less common or more complex presentations and conditions
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Genetic and Metabolic Medicine - Investigations, procedures and clinical assessment tools
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Genetic and Metabolic Medicine - Important specific issues
-
Haematology and Oncology - Key presentations and conditions
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Haematology and Oncology - Less common or more complex presentations and conditions
-
Haematology and Oncology - Investigations, procedures and clinical assessment tools
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Haematology and Oncology - Important specific issues
-
Immunology and Allergy - Key presentations and conditions
-
Immunology and Allergy - Less common or more complex presentations and conditions
-
Immunology and Allergy - Investigations, procedures and clinical assessment tools
-
Infectious Diseases - Key presentations and conditions
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Infectious Diseases - Less common or more complex presentations and conditions
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Infectious Diseases - Investigations, procedures and clinical assessment tools
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Infectious Diseases - Important specific issues
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Neonatal and Perinatal Medicine - Key presentations and conditions
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Neonatal and Perinatal Medicine - Less common or more complex presentations and conditions
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Neonatal and Perinatal Medicine - Investigations, procedures and clinical assessment tools
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Neonatal and Perinatal Medicine - Important specific issues
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Nephrology and Urology - Key presentations and conditions
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Nephrology and Urology - Less common or more complex presentations and conditions
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Nephrology and Urology - Investigations, procedures and clinical assessment tools
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Nephrology and Urology - Important specific issues
-
Neurology - Key presentations and conditions
-
Neurology - Less common or more complex presentations and conditions
-
Neurology - Investigations, procedures and clinical assessment tools
-
Neurology - Important specific issues
-
Respiratory and Sleep Medicine - Key presentations and conditions
-
Respiratory and Sleep Medicine - Less common or more complex presentations and conditions
-
Respiratory and Sleep Medicine - Investigations, procedures and clinical assessment tools
-
Rheumatology - Key presentations and conditions
-
Rheumatology - Less common or more complex presentations and conditions
-
Rheumatology - Investigations, procedures and clinical assessment tools
-
Rheumatology - Important specific issues