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JDocs Framework
Learning Outcomes and Professional Standards
RACS - The College of Surgeons of Australia and New Zealand. Royal Australasian College of Surgeons.
RACS JDocs Framework Version 1.1 November 2014
Table of contents
Terms and abbreviations
Introduction
JDocs resources
In summary
7
39
41
42
Direct observation
42
Multi-source feedback
42
43
Simulation
43
43
Knowledge assessment
43
44
46
46
Section 6: Acknowledgements
47
DCT
MEO
PGY
Post-graduate Year
SET
Introduction
Increased numbers of medical graduates and limited vocational training places have resulted in junior doctors
spending more time in non-accredited positions, with subsequent uncertainty about their career path and
learning expectations.
To help guide junior doctor career development during the early prevocational years, The Royal Australasian
College of Surgeons (the College) has established JDocs, a competency framework (JDocs Framework)
supported by a suite of learning and assessment resources. JDocs is available to any doctor registered in
Australia and New Zealand, from and including internship, where the level of engagement is determined by the
junior doctor.
Although JDocs does not guarantee selection into any procedural specialty training program, by engaging
with the JDocs Framework and its supporting resources, the junior doctor can recognise the skills and
performance standards expected prior to applying to vocational specialist training.
The JDocs Framework
The JDocs Framework is aligned to the Colleges nine surgical core competencies (pp. 78) and describes the
many tasks, skills and behaviours that the junior doctor should achieve at defined levels during post-graduate
years (PGY) 1 to 3 and beyond.
Extensive consultation with stakeholders has been undertaken, including senior medical students, junior
doctor focus groups, hospitals and training networks, as well as State post-graduate medical training
groups, to inform the development of the JDocs Framework. The College has also referred to the Australian
Curriculum Framework for Junior Doctors (ACF), the Australian Medical Councils (AMC) National Internship
Framework and the Prevocational Program recently introduced by the Medical Council New Zealand (MCNZ).
To complement the JDocs Framework, a number of key clinical tasks have been developed to facilitate
assessment of the junior doctors level of performance in the workplace. The key clinical tasks are multicompetency constructs around real clinical work, for example, leading a ward round or looking after a sick
patient, and are applicable to many procedural medical careers. (Refer to p. 39 for further information).
JDocs resources
To guide the education and professional development of the junior doctor, a number of educational resources
have been identified to support the JDocs Framework, which will be available from the JDocs website (http://
jdocs.surgeons.org) in early 2015. An annual subscription fee is payable to access the full suite of resources.
(Refer to p. 46 for additional information).
In summary
JDocs is a competency framework supported by a suite of learning and assessment resources that:
is useful for identifying those skills required to pursue a procedural medical career;
promotes flexible and self-directed learning;
provides guidance for the self-directed, motivated junior doctor considering applying to specialty training
programs; and
provides assessment opportunities to record and log surgical experiences and capture evidence of personal
achievements.
It is also anticipated that:
The self-directed and motivated junior doctor will work with hospital supervisors, consultants, MEOs and
others in the workplace to identify those clinical placement and development opportunities that align to
the JDocs Framework.
The workplace will be able to use the JDocs Framework to support the junior doctor in identifying those
learning outcomes that can be attained on clinical placements, and provide opportunities for assessment
and feedback.
Providers of educational resources can use the JDocs Framework to identify those activities or events
that can be accredited by the College, with approval to use the Colleges accreditation logo.
Each of the Colleges nine surgical core competencies of the JDocs Framework has been described in stages
appropriate for each of the three PGY levels, as well as those beyond this. Each competency is of equal
importance.
As shown in Figure 1, the nine competencies can also be broken down into three broad classifications, that is,
being a safe and competent clinician, being a medical professional and being a collaborative team member.
It is therefore possible that through demonstration of a particular task, a junior doctor can complete a number
of learning outcomes.
FIGURE 1
The daily professional tasks, undertaken
by a junior doctor in a clinical
environment, can be described noting
these competencies and represent the
performance level that the junior doctor
should be working towards.
PGY1
Year
Standards: Communication
Communication
10
PGY1
Year
Standards: Communication
11
PGY1
Year
Standards: Communication
12
PGY2
Year
Standards: Communication
13
PGY2
Year
9. Participate in shared decision-making activity
involving patients, families and relevant health
professionals, such as development of a care
plan (note comments about open disclosure with
Communication)
Standards: Communication
14
PGY3
Year
Standards: Communication
15
PGY3+
PGY3
Year
Standards: Communication
16
PGY1
Year
Health advocacy
Professionalism
17
PGY1
Year
18
PGY2
Year
19
PGY2
Year
20
PGY3
Year
Portfolio analysis
Incorporate teaching into clinical work
Undertake induction of medical students, peers
and juniors
Identify issues of stress relating to educational
activities and promote strategies for positive
change
21
PGY3
Year
22
PGY3+
PGY3
Year
23
PGY1
Year
Considering options
Planning ahead
Implementing and reviewing decisions
Technical expertise
Medical expertise
24
PGY1
Year
25
PGY1
Year
26
PGY2
Year
27
PGY2
Year
28
PGY2
Year
29
PGY3
Year
30
PGY3
Year
PGY1
2. Personal protection
Scrubbing
Gowning
Gloving
Splash protection
1. Prepping and draping
Establish and maintain sterility and integrity of operative field
Appropriate selection and application of skin preparation agent
PGY2
2. Surgical etiquette
Participate in surgical checklist
Participate in team time out
1. Positioning the patient
PGY3
31
Level
Skill 2: Instrumentation
1. Scissors
Able to name types of scissors and explain indications for appropriate and safe use
Safe and correct handling and use
Explain mechanism of action of scissors
Demonstrate care of scissor blades
Able to pass and receive scissors safely
2. Needle holders
Select needle holder of appropriate weight and length
Safe and correct handling and use
Pass and receive needle holders safely
3. Tissue-holding forceps
Selection of appropriate forceps (thumb unlocking; locking; tooth and non-tooth)
Safe and correct handling and use
PGY12
4. Retractors
Selection of appropriate retractors (hand-held; self-retaining)
Safe, correct handling; use and risk of tissue damage
5. Scalpel
Select appropriate blade
Safe and correct mounting of blade
Able to explain principles of holding and using
Able to pass scalpel safely using a safety dish
Perform a long cut with square edges at appropriate depth, without slicing or multiple
passes
6. Skin staples
Recognise indications for use of skin staples
Correct application
Safe removal
32
Level
PGY2
heat dissipation, capacitive coupling, short circuit, tissue impedance (including risk to
pedicles) and the effect of desiccation, arcing, insulation failure, plume management,
ignition hazards and with implanted devices
1. Recognise indications for use of diathermy
PGY3
Level
PGY12
PGY3
2. Suture needles
Select correct needle size and curvature
Round bodied vs. cutting
Single vs. double armed
33
Level
PGY12
Dressing
Debridement
Wound closure: healing by primary intention
1. Conform to principles of wound management as directed
Wound classification: clean vs. contaminated; necrotising infections; mechanism of
wounding
Wound healing and factors affecting wound healing
Wound closure: healing by secondary intention; delayed primary closure
PGY23
Level
PGY12
Nasogastric
Nasoenteric
Intercostal catheter underwater seal drains
Urethral catheter
Arterial access
Venous access: peripheral
1. Safely insert and/or take out:
PGY3+
34
Level
PGY12
Level
PGY12
Short-acting
Long-acting
Vasoactive agents
3. Pharmacokinetics
Dosage
Duration of action
4. Adverse effects and management
Local injury
Systemic effects
35
Level
PGY12
Nasal prongs
Mask
Reservoir mask
CPAP
Recognise indications for circulatory support
3. Safe practices for circulatory support
Emergency venous access
Monitoring and assessment
External haemorrhage control
IV fluid resuscitation
Transfusion of blood
Transfusion of blood products
Management of complications
Prevention of hypothermia
36
Insertion of IV cannula
Pleural/peritoneal tap
Miscarriage
Acute abdomen
Abdominal sepsis
Tendon injury
Compartment syndrome
Burns
Septic shock
Gastrointestinal bleeding
Trauma
37
38
Fever
Dehydration
Loss of consciousness
Syncope
Headache
Toothache
Upper airway obstruction
Chest pain
Breathlessness
Cough
Back pain
Nausea and vomiting
Jaundice
Abdominal pain
Gastrointestinal bleeding
Constipation
Diarrhoea
Dysuria /or frequent
micturition
Oliguria and anuria
Pain and bleeding in early
pregnancy
Agitation
Depression
Confusion
Asthma
Respiratory infection
Chronic obstructive pulmonary
disease
Obstructive sleep apnoea
Liver disease
Acute abdomen
Renal failure
Pyelonephritis and urinary tract
infections
Urinary incontinence and retention
Menstrual disorders
Sexually transmitted infections
Anaemia
Bruising and bleeding
Management of anticoagulation
Cognitive or physical disability
Substance abuse and dependence
Psychosis
Depression
Anxiety
Deliberate self-harm and suicidal
behaviours
Paracetamol overdose
Benzodiazepine and opioid
overdose
Common malignancies
Chemotherapy and radiotherapy
side effects
The sick child
Child abuse
Domestic violence
Dementia
Functional decline or impairment
Falls, especially in the elderly
Elder abuse
Poisoning/overdose
PGY3+
Medical Expertise
Communicat
ion
4, 5,
9, 10
4, 5,
6
1-7,
10
4, 7
2, 4,
8
3, 4, 5,
6, 10
4, 7, 9
4, 10
a
an
in
6, 8
7, 9
4, 6
Collabora
tion
&
T
e
am
wo
rk
Co
m
6, 8
7, 9
Collabora
tion
& te
a
m
wo
rk
PGY
7 Respect the roles and responsibilities of other professionals within the health care
1
team; listen to their concerns about the patient
PGY 8 Recognise expertise of others especially roles of other health team members
2
7 Negotiate with other units to achieve team and patient needs. Collaborate
effectively with other specialist teams involved in the patient's care
PGY 9 Effectively prioritise and communicate about multiple medical conditions with
3+
varying disease severity and engage junior doctors, nursing and ancillary staff in
ward rounds
4, 7
Profess
iona
lism
1-6,
9, 10
Hea
th
l
t
e
h
A
w
dvo
or
cac
y
4, 5,
6
2, 3,
7, 8,
10
ork
amw
& te
n
hip
tio
ders
ica t & Lea
n
un
me
m
ge
1, 3,
4,
7, 8
Ex
p
ssionalism
Profe
1, 2, 5,
8, 9
1, 4, 5,
7
Tec
hni
ca
l
1-4, 6, 10
Ap
p
sit req ropr
ua uir iat
tio em e
n / en to
cir ts leve
cu of l &
ms the
tan
ce
DM
&C
nt
e
m
2, 4
e
tis
er
Ju
dg
e
cher
/ Tea
olar
Sch
PGY2
ce
la
kp
PGY1
39
It requires:
General medical knowledge, knowledge of the specialty content, skills of assimilation of medical data about
a group of patients, and the ability to present succinctly. The ability to summarise progress and discuss the
next steps in the patients management is highly valued.
Punctuality, professional demeanour and communication. The ward functions as a complex healthcare team
within which the junior doctor has a collaborative role. The junior doctor should have a positive attitude and
be able to delegate tasks to the medical team during the round. When done well, teaching can be included or
conducted after the main round.
Support for this task can be accessed as follows:
A suite of educational resources is available from the JDocs website (http://jdocs.surgeons.org) to help
support the skills and knowledge acquisition as defined by the JDocs Framework. Level of engagement will
be self-directed, with individual choice of which activities and resources are accessed or completed. (Please
see p. 46 for further information.)
The informed junior doctor will be able to articulate needs and seek guidance from their Director of
Prevocational Education and Training, Supervisor and/or MEO to discuss clinical placement assessment
opportunities.
Assessment of this task could be captured in a number of ways:
As part of end-of-term assessment
Recorded by uploading the relevant documents into the ePortfolio
Following three well-performed ward rounds, one could accept that the junior doctor could be trusted to
perform the rounds to a suitable standard in the absence of the supervising consultants. Post ward round
follow-up could include discussion with the senior ward nurses and the more junior doctors about how the
ward rounds were being done. An extensive scoring sheet is not required, but the supervising consultants need
to consciously observe and follow-up as described.
In summary, the key clinical tasks can be used to demonstrate achievement of the competencies and
standards outlined in the JDocs Framework (please see pp. 938 for further information).
40
Open disclosure
Supervision of juniors doctors
Interprofessional ward/unit meeting
Planning an operating list
Maintaining professional work behaviour
Wound management
Surgical technical skills
Basic wound care tubes and drains
Empathic conduct of bad news discussion
Detailed descriptors of these tasks will be available from the JDocs website in 2015.
41
Mini-clinical evaluation
exercise (Mini-CEX)
Direct observation of
procedural skills (DOPS)
Key clinical tasks represent daily professional activities for the medical
professional role at early registrar level where level of performance can be
assessed.
Multi-source feedback
Multi-source
feedback tool
42
Progress reports
Simulation
Training courses
MALT
The Colleges Morbidity Audit and Logbook Tool (MALT) includes a junior
doctor logbook, where cases and procedures against different levels of
supervision can be logged. This is based on the international SNOMED
descriptors of medical illness, treatments and operations.
Tailored reporting of supervised (key) procedures can be generated in a format
for supervisor sign off.
RACS ePortfolio
(Available in 2015)
Knowledge assessment
Generic Surgical
Science Examination
Junior doctors are eligible to apply for the GSSE from 2015. The exam
tests anatomy, physiology and pathology to a high standard. Practice bank
resources are available as part of the JDocs subscription fee.
43
LE
P
M
A
S
Having an activity, event or course accredited by the College demonstrates it meets the educational standards,
as defined by the College, and provides a means by which external education providers can be recognised by the
College.
The College accredits the following activities (other activities may apply):
tertiary courses*
conferences events
workshops
events
short courses
online courses.
For further information on how to apply for accreditation, please visit the course accreditation page, available from
the College website (www.surgeons.org).
The following resources have been accredited by the College and deemed suitable for prevocational doctors.
Anatomy courses
44
Provider
Course
Duration
Location
16 weeks (3 hours/week)
VIC
12 weeks (3 or 5 hours/week)
NSW
University of Sydney
9 weeks full-time
NSW
1 year full-time
NSW
3 days
QLD
11 modules, 23 weeks
QLD
University of Tasmania
TAS
Monash University
20 weeks (2 hours/week)
VIC
Anatomy courses
Provider
Course
Duration
Location
University of Melbourne
18 weeks
VIC
University of Otago
1 year full-time
NZ
Provider
Course
Duration
Location
2.5 days
AUS/NZ
3 days
AUS/NZ
2 days
AUS/NZ
2.5 days
AUS/NZ
2 days
AUS/NZ
1 day
WA
12 days
WA
Provider
Course
Duration
Location
Australian Society of
Otolaryngology Head and
Neck Surgery (ASOHNS)
2 days
AUS/NZ
Macquarie University
Master of Surgery
2 years full-time
NSW
University of Sydney
23 years full-time
NSW
2 weeks full-time
NSW
13 years
Online
University of Queensland
1 semester full-time
QLD
Skills courses
Other courses
45
46
Section 6: Acknowledgements
The detail of the JDocs Framework has been compiled by the College, with reference to the following
resources:
ASSET Committee Skillbox surgical skills videos
Australian Medical Council (AMC): Prevocational Standards for Accreditation
Confederation of Postgraduate Medical Education Councils (CPMEC): Curriculum Framework for Junior
Doctors
Frank, J.R. (Ed) 2005. The CanMEDS 2005 physician competency framework. Better standards. Better
physicians. Better care. Ottawa: The Royal College of Physicians and Surgeons of Canada (CanMEDS http://
www.royalcollege.ca/portal/page/portal/rc/canmeds)
Medical Council New Zealand
Royal Australasian College of Surgeons: Becoming a competent and proficient surgeon: Training standards
for the nine RACS Competencies
Royal Australasian College of Surgeons: Essential Surgical Skills
The JDocs Framework has been developed by:
Stephen Tobin, Dean of Education
Kathleen Hickey, Director, Education Development and Assessment
Jacky Heath, Manager, Prevocational & Online Education
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