When presenting cases, consistently include essential information while excluding what is extraneous Write referral letters, via dictation or typing, that are concise, accurate and contain all required information to accepted practice standards and appropriate to the audience 4.2 Present all relevant information to expert colleagues when acting to obtain their involvement Provision and coordination of care 5. Evaluate referrals 5.1 Discern patients who are appropriate for advanced physiotherapy management in accordance with individual strengths or limitations, any or organisational restrictions on practice, the environment, the patient profile/needs and within defined work roles Consistently discern patients who are appropriate for OAHKS clinic Consistently discern patients who are not appropriate for OAHKS clinic local organisational requirements of OAHKS patient flows, including triage of referrals, booking of appointments and protocols for patients who fail to attend or are not contactable 5.2 Discern patients who are appropriate for management in a shared-care arrangement in accordance with individual strengths or limitations, any or organisational restrictions on practice, the environment, the patient profile/needs and within defined work roles 5.3 Defer patient referrals to relevant health professionals (including other physiotherapists) when limitations of skill or job role prevent the patient’s needs from being adequately addressed, or when indicated by local triage procedure Ensure relevant health professionals receive an accurate and timely handover when transferring patient care Document referral/handover clearly with all necessary information 5.4 Prioritise referrals based on patient profile/need, organisational procedure or targets, and any local factors 5.5 Communicate action taken on referrals using established organisational processes
advanced musculoskeletal physiotherapy services (under the direction and supervision of a consultant) consultant, rheumatologist and/or GP. For example, recognise from patient assessment findings that an inflammatory condition may be present, and that pathology tests may be required and interpreted in consultation with orthopaedic consultant, rheumatologist and/or GP Convey accurate and relevant patient assessment findings to the orthopaedic consultant, rheumatologist and/or GP to ensure the pathology request form conveys full and accurate information Follow the local organisation’s policies and procedures regarding the referral and requesting of pathology Interpret routine pathology tests ordered for patients with OA and understand the significance of the findings regarding the medical management to be implemented by the medical team 8.2 Determine the indication for pathology testing based on assessment findings and clinical decision-making rules 8.3. Identify the appropriate test(s) consistently and act to gain authorisation as required 8.4 Convey all required information to appropriate personnel when initiating pathology tests 8.5 Interpret routine pathology test results for patients with common and/or complex conditions, as relevant to the practice context and in consultation with expert colleagues when required 8.6 Meet threshold credentials and/or external learning and assessment processes set by the organisation, governing body, or state/territory legislation 9. Apply the use of therapeutic medicines in advanced musculoskeletal physiotherapy services 9.1 Determine the indication and appropriate medication requirements from information obtained from the history taking and clinical examination, and liaise with a relevant health professional regarding this
15. Perform an appropriate musculoskeletal assessment and implement a management plan for patients presenting with OA of the hip or knee 15.1 Demonstrate an in-depth knowledge of the aetiology, pathology and clinical findings of OA Describe modifiable and non-modifiable risk factors associated with OA Distinguish key features of OA from other inflammatory conditions, such as rheumatoid arthritis Describe the prevalence of OA within the community and the impact of the disease on the individual, population and healthcare system Demonstrate an understanding of the stages and progression of OA and the implications on assessment and management Use recognised published guidelines on managing OA to guide practice 15.2 Perform a complex assessment for patients presenting for musculoskeletal assessment of hip or knee pain Perform a musculoskeletal examination of the knee or hip with appropriate testing of active and passive range of movement, ligamentous structures, muscle length, gait, balance, leg length and alignment, special tests and functional abilities as required to determine a problem list relevant to the individual As appropriate, demonstrate a complex assessment of other joints and spine, including neurological testing Demonstrate advanced clinical reasoning in analysing findings Be able to demonstrate an advanced knowledge about possible differential diagnoses. These should include septic arthritis, inflammatory arthritis, gout, ACL and ligamentous injuries, tumour and spinal conditions. 15.3 Ensure all red flags are identified in the assessment process, link red flags to diagnoses not to be missed and take appropriate action in a timely manner 15.4 Determine the indication for imaging based on assessment findings and decision-making rules
Visceral/Vascular The AMP demonstrates knowledge of referred pain patterns from visceral organs, for example: The AMP demonstrates knowledge of vascular conditions that may present as musculoskeletal conditions, for example: (and vessels) Lung Kidney Stomach Intestines Gall bladder DVT Vascular claudication Abdominal aortic aneurysm Neurology The AMP is able to discuss at a basic level signs and symptoms commonly associated with neurological problems such as: Multiple sclerosis Motor neurone disease Parkinson’s disease Cerebral vascular disease Neurofibromatosis 3. Radiology Radiation Safety The AMP demonstrates awareness of radiation safety that includes: Principles of ionising and non-ionising radiation Risks and contraindications of each modality: plain film CT MRI ultrasound nuclear medicine interventional radiology bone scans pregnancy and protection of the fetus
Indications for imaging The AMP can describe the clinical decision-making rules to determine the for imaging of the: Hip and pelvis Knee Spine The AMP can describe the indications, advantages and disadvantages of the imaging modalities – plain film, CT, MRI, ultrasound, nuclear medicine – in the following regions: Hip and pelvis Knee Lumbar spine In the presence of a prosthesis The AMP describes the imaging pathway for the following suspected conditions: OA Fractures and dislocations Cartilage and osteochondral lesions Tendon and muscle ruptures Ligamentous injuries Degenerative joint conditions Avascular necrosis Stress fractures Acute osteomyelitis Bony metastases Soft tissue mass Multiple myeloma DVT (outline Wells’ criteria) Requesting Imaging
The AMP has the ability to identify abnormal findings on film of cause that require a medical review and may be diagnosed by the medical team such as: Acute osteomyelitis Bony metastases Multiple myeloma Foreign bodies Soft tissue mass 5. Pharmacology The AMP demonstrates knowledge of relevant state/ territory legislation regarding use of medicines The AMP demonstrates an awareness of pharmacology relevant to managing musculoskeletal conditions including: The AMP demonstrates knowledge about mode of action, indications, precaution, contraindications, drug interactions, adverse reactions and side effects and dosage of the following drug classes: Clinical pharmacology Pharmacotherapeutics Pharmacokinetics and pharmacodynamics Special considerations for certain populations (for example, post arthroplasty, older adults) International, national and organisational clinical guidelines in relation to medicine use Analgesics Antibiotics Anti-inflammatories Disease-modifying antirheumatic drugs (DMARDs) Neuropathic medications Corticosteroids Opioids Diabetic medications 6. Pathology
Promote healthy lifestyle behaviours to patients with diabetes who have had arthroplasty surgery 8. Communication Verbal communication The AMP demonstrates advanced skills in communicating at all levels and in particular demonstrates the ability to: Use concise, systematic approach to verbally presenting cases to expert colleagues Acknowledge time restraints and competing demands on expert colleagues and approaches only when appropriate Follows ISBAR approach when indicated and appropriate Documentation The AMP will have a demonstrated ability to: Correctly document in the medical record by following all: local policies and procedures national standards professional standards Record accurate and complete clinical that are either electronic or legibly hand written Document clinical that are relevant, objective, accurate and concise Consent The AMP will have a demonstrated knowledge of: The AMP will have a demonstrated ability to: Legislation regarding patient rights and consent to treatment Local organisational guidelines for consenting patients The barriers that patients’ capacity to consent Clearly educate patients of the risks and benefits of investigations or procedures prior to gaining consent Identify patients that are not able to consent Troubleshoot when unable to obtain consent
Supervised (S) Safe Accurate Achieved intended outcome Behaviour is appropriate to context Proficient Confident Reasonably expedient Occasional supportive cues Assisted (A) Safe Accurate Achieved most objectives for intended outcome Behaviour generally appropriate to context Proficient throughout most of the performance when assisted Frequent verbal and occasional physical directives in addition to supportive cues Marginal (M) Safe only with guidance Not completely accurate Incomplete achievement of intended outcome Unskilled Inefficient Continuous verbal and frequent physical directive cues Dependent (D) Unsafe Unable to demonstrate behaviour Lack of insight into behaviour appropriate to context Unskilled Unable to demonstrate behaviour/procedure Continuous verbal and physical directive cues X Not observed Adapted from: K N 1983, ‘Criterion-referenced definitions for rating scales and clinical evaluation’, Journal of Nursing Education, 22(9):376–381.
ELEMENTS AND PERFORMANCE CRITERIA Did the candidate provide evidence of the following? Link to comp. standard Performance rating scale X or Dependent Marginal Assisted Supervision Independent Communication Communication with expert colleagues is concise, systematic and at appropriate and includes liaising regarding: assessment and management plan differential diagnosis use of medicines and imaging 4.1, 7.6, 9.5, 6.5, 11.2 All relevant information presented to expert colleagues 4.2 Provision and coordination of care Appropriate patients allocated from GP referrals 5.1 Shared care management instigated appropriately if applicable 5.2 Defers patients to other professionals appropriately and a thorough handover is conducted as required 5.3, 11.5, 11.7 Perform health assessment/examination Conducts an individualised, culturally appropriate and effective patient interview 6.1 Preliminary hypothesis formed 6.2 Differential diagnoses identified 6.2 Conducts an individualised, appropriate and effective musculoskeletal assessment 6.3 6.4 ‘Red and ‘yellow flags’ are identified, and appropriate action taken 15.3 Apply the use of radiological investigations in advanced musculoskeletal physiotherapy Imaging selected is indicated, risks are minimised and appropriate modality selected Radiological plain-film images are interpreted systematically and accurately 7.5 15.5 Advanced clinical decision making Findings interpreted and synthesised to confirm the diagnosis 10.1 Management plan shows well-developed judgement, with synthesis of all relevant factors 10.2 Formulate and implement a management/intervention plan Plan is evidence-based, appropriate and made in collaboration with patient 11.1, Facilitates all prerequisite investigations and information prior to consultation/referral 11.3 Referral and follow-up arranged appropriately 11.4 Provides appropriate education and advice to patient 11.6 Monitor and escalate care Monitors the patient response and progress throughout the intervention appropriately 12.1 Obtain patient consent Explains own activity as it specifically relates to the practice context and checks that the patient agrees before proceeding 13.1 Considers the patient’s capacity for decision making and consent, informs of risks and confirms understanding 15.6
Example of a possible curriculum timeline (for a physiotherapist who has met the selection criteria working as an advanced musculoskeletal physiotherapist in OAHKS) ORIENTATION Block 1 2 Block 3 Block 4 Orientation program Complete Learning needs analysis Part A and B and discuss in collaboration with clinical lead to develop individualised Learning and assessment plan SELF-DIRECTED LEARNING MODULES Radiology Radiation safety Complete quiz (need 80% pass rate) Communication SELF-DIRECTED LEARNING MODULES OA Radiology Indications for imaging Requesting imaging IN-SERVICE: Orthopaedic surgeon: what makes a good surgical candidate? SELF-DIRECTED LEARNING MODULES Radiology Interpreting imaging (OA) IN-SERVICE: Radiology Interpreting film? SELF-DIRECTED LEARNING MODULES Arthroplasty IN-SERVICE: Orthopaedics: arthroplasty surgery SELF-DIRECTED LEARNING MODULES Pharmacology IN-SERVICE: Pharmacy or anaesthetics – analgesia MEET WITH MENTOR Discuss Learning needs analysis Part A and B OBSERVE/SHADOW CLINIC REDUCED CLINICAL LOAD WITH ACCESS TO CLINICAL LEAD MEET WITH MENTOR Formative assessment Go to theatre? presentation 1 Workplace observation
5 Block 6 7 Block 8 Block 9 Competency assessment SELF-DIRECTED LEARNING MODULES Pathology IN-SERVICE: Pathologist Routine bloods SELF-DIRECTED LEARNING MODULES Differential diagnosis IN-SERVICE: Rheumatologist Differential diagnosis OA vs other inflammatory disorders SELF-DIRECTIED LEARNING MODULES Diabetes IN-SERVICE: Diabetes nurse educator REVISION REVISION Oral appraisal Performance appraisal Further case-based presentations as required Present clinical log and professional practice portfolio and all completed assessment tasks Any other documented tasks MEET WITH MENTOR Formative assessment Record-keeping audit presentation 2 MEET WITH MENTOR Formative assessment Workplace observation Case-based presentation 3 Complete Radiology interpretation quiz MEET WITH MENTOR Repeat Competency standard tool Case-based presentation 4