DESCRIPTION

Training level Gain experience / knowledge in internal medicine under supervision.

EXPERIENCE

Preferred to have had some exposure to medicine at post graduate level, but may have little experience when starting at this level.

DIAGNOSTIC

May possess limited diagnostic skills at entry.

MANAGEMENT

Able to initiate basic management.

RESUSCITATION

Skills outlined in Annexure A.

PROCEDURAL SKILLS

May possess limited skills at entry.

DATA INTERPRETATION

Able to interpret basic haematology, biochemistry, microbiology, plain x-rays, ECG, spirometry.

PHARMACOLOGY

Understand basic pharmacological principles of commonly used medications.

GENERAL

Possesses only limited knowledge of management of medical problems.

DESCRIPTION

Have experience and knowledge so may care for patients in hospital in semiautonomous role where a senior medical person is continually available on site for consultation (Senior registrar, VMO, Staff Specialist).

EXPERIENCE

Greater than twelve months full time (or its part time equivalent) experience with medical inpatients at the SRMO or Registrar level.

OR greater than 6 months full-time (or its part-time equivalent) experience with medical

inpatients plus other relevant experience all at SRMO or Registrar level, the combined total of which is >12 months full-time (or its part time equivalent).

DIAGNOSTIC

Able to interpret results of history, physical examination, pathology, ECG and radiological investigations in order to arrive at a diagnosis or differential diagnosis for common medical presentations; though assistance or referral may be required for the diagnosis of some presentations. MANAGEMENT Able to manage stable patients. Able to stabilise unstable patients. Able to take daily responsibility for ongoing management of common medical problems.

RESUSCITATION

Skill as outlined in Annexure A.

PROCEDURE SKILLS

IV access peripherally
Venesection
Taking ABG
IV fluid management
N/G tube placement
Proctoscopy
Urethral catheterization
L.P.
Cardioversion
Uncomplicated intubation

DATA INTERPRETATION

Full understanding of:

ECG
Haematology
Biochemistry
Microbiology
X-rays and contrast studies.

PHARMACOLOGY

Understand pharmacological principles of most drugs used in hospital.

GENERAL

Able to initiate management and continue ongoing management for the uncomplicated medical presentations, but assistance may be required for the more complex presentations.

DESCRIPTION

Competently functions independently in care of medical patients. Able to supervise.

(MMO may need to consult the specialist on call -this does not constitute supervision).

EXPERIENCE

> 24 months full-time (or its part-time equivalent) experience with medical patients at SRMO or Registrar level.

OR

>12 months full-time (or part-time equivalent) experience with medical patients plus other relevant experience all at SRMO or Registrar level, the combined total of which is > 24 months full-time (or its part-time equivalent).

AND

Must have attained Level II or greater in at least one additional area.

DIAGNOSTIC

Able to interpret results of history, physical examination, pathology and radiological investigations in order to arrive at a diagnosis or differential diagnosis for a complete and comprehensive range of medical presentations.

MANAGEMENT

Able to manage comprehensive range of medical patients; also must have the following clinical skills

MEDICAL CONDITION	CLINICAL SKILLS
1. Cardiac AMI Acute/Chronic CCF H.T. Angina - stable & unstable	STK/rTPA (Thrombolysis) Cardioversion - acute/elective Central line/monitoring CVP C.P.A.P. Pharmacy management Inotropic support Transvenous pacemaker
2. Respiratory CAL Asthma Pneumonia P.E. Pneumothorax Effusions Interstitial lung diseases Malignant lung diseases	O2 therapy/interpretation of ABG Antibiotic management Intubation Ventilation Oxylog Transport Pleural aspiration Intercostal drainage Pleural biopsy Pleurodesis
3. Endocrine / Metabolic Diabetes / Ketoacidosis Thyroid Electrolyte imbalance Na+/K+/Ca++ Hyperuricaemia Osteoporosis	Insulin therapy Endocrine homeostasis Fluid therapy Electrolyte homeostasis Pharmacological management
4. Circulatory Shock Anaemia Thrombocytopaenia Bleeding disorders Clotting disorders Septicaemia	Circulatory resuscitation - septic shock - cardiogenic shock - anaphylactic shock Blood transfusions Manage DVT Manage coagulation disorders
5. Neurological CVA Headache Meningitis Encephalitis Epilepsy Dementia Parkinsons Neuropathy/Guillain Barre	LP plus interpretation Indications for CAT / MRI Management of changes in G.C.S. and unconscious patient
6. Gastrointestinal: Gl bleed upper and lower Peptic ulcer Hepatitis Pancreatitis Gastroenteritis Overdose	Resuscitation of shocked patient Sigmoidoscopy Principles of rehydration Manage electrolyte disturbance Peritoneal Lavage and diagnostic tap Indications for surgical review
7. Musculoskeletal / Dermatology Rheumatoid arthritis Osteo-arthritis Connective tissue disease Common dermatological conditions
8. Renal Renal failure - acute/chronic Urinary obstruction Haematuria Proteinuria Infections	Stabilisation plus transfer for renal dialysis Catheterisation - urethral / supra pubic
9. Geriatric Care
10. Palliative Care
11. Anaesthetic Capable of anaesthetising patient in absence of specialist, especially rapid sequence induction and transfer of ventilated patient.

RESUSCITATION

Skills as outlined in Annexure A.

DATA INTERPRETATION

Wide understanding and application unsupervised of:

Haematology
Biochemistry
Microbiology
Radiology
Pharmacology
Toxicology in all clinical situations

LEVEL 1

- basic CPR
- bag/mask ventilation
- peripheral venous access
- ECG interpretation/recognition of arrhythmias
- emergency cardioversion (unconscious pt)
- appropriate use of adrenaline, atropine and lignocaine

LEVEL 2

- all items specified at level 1
- establish the uncomplicated airway and manually ventilate
- large bore peripheral venous cannula
- intraosseus cannula
- simple use of fluid and blood products
- use of first line anti-arrhythmics
- needle intercostal catheter
- uncomplicated intubation

LEVEL 3

- all items specified at levels 1 & 2
- maintenance of the established uncomplicated airway
- ability to recognise the complicated airway and to possess an appropriate complicated airway drill
- use of mechanical ventilation
- complicated venous access (eg) peripheral venous cutdown, central venous access
- complicated use of fluid and blood products
- cardioversion of the conscious patient
- use of second line anti-arrhythmic
- use of transcutaneous pacemaker
- intercostal catheter
- complicated intubation

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