Clinical Competency Rubric

1. Communication and Consultation Skills

• Communicates appropriately to sociocultural context
• Engages patient to explore symptoms, ideas, concerns, expectations
• Adapts communication style to patient literacy and context
• Active listening, empathy, and rapport building
• Effective in difficult or routine situations
• Uses varied formats (verbal, written, electronic) for education
• Motivates and supports behavioural change
• Consults efficiently and structures consultations effectively
• Prioritises agendas (patient and clinician)
• Safety-netting and follow-up arrangements

Aboriginal and Torres Strait Islander context

• Uses culturally safe communication methods
• Incorporates cultural beliefs and health perspectives
• Addresses barriers to therapeutic relationships

Rural context

• Maintains remote communication strategies and infrastructure
• Chooses contextually appropriate communication modes

Step	Action	How This Demonstrates Competency	CCE Context Tips
1. Culturally Appropriate Communication	Adjust language, gestures, and interaction based on patient’s cultural background and preferences	Communicates appropriately to sociocultural context	In ATSI care, use non-confrontational body language; acknowledge connection to Country
2. Explore ICE (Ideas, Concerns, Expectations)	Ask open-ended questions: “What do you think is going on?” “What are you hoping we can help with today?”	Engages patient meaningfully and builds shared understanding	Use empathetic tone and explore fears/expectations gently
3. Adapt to Patient Literacy and Context	Simplify medical jargon (e.g., “heart problem” vs “cardiomyopathy”); use visual aids or interpreter if needed	Adapts to patient’s literacy level, language, cognitive status	Important for elderly, non-English speakers, ATSI patients
4. Build Empathy and Rapport	Use reflective listening,Nodding, paraphrasing, Open body language, and Validation: “That sounds really hard.”	Demonstrates active listening and emotional attunement	Name emotions when appropriate; pause and allow silence
5. Manage Challenging or Routine Consults	Stay calm and respectful in conflict “I understand it’s frustrating to wait—thank you for your patience.” maintain structure in routine follow-ups	Effective in both routine and emotionally charged encounters	remain composed under simulated stress
6. Use Multimodal Education	Explain verbally, give printed summary, offer My Health Record upload	Uses verbal, written, and electronic formats for education	Ask: “Would you like me to write that down for you?”
7. Support Behaviour Change	Use motivational interviewing: “What matters most to you about improving your health?” “What would be the benefits for you if you stopped smoking?”	Motivates patient and facilitates action planning	Celebrate small wins; acknowledge ambivalence
8. Structure and Time Manage Consult	Prioritise agenda: “We only have 15 mins—what’s the most important thing today?”	Consults efficiently and structures well	Don’t forget to summarise at end; track time if multitasking
9. Prioritise Agendas (Patient + Clinician)	Address patient concerns, then segue into preventive care or chronic condition reviews	Balances patient-led and doctor-led goals	Negotiate follow-up if everything can’t be covered in one visit
10. Safety-Net and Arrange Follow-Up	Provide red flag education: “If you develop worsening pain or fevers, call us or present to ED.”	Ensures continuity, anticipates deterioration	Document follow-up clearly in shared plan (e.g., My Health Record)

Aboriginal and Torres Strait Islander Context

Action	Competency Demonstrated	CCE Tip
Acknowledge cultural identity and community role	Asking about who is important in the patient’s community or family and using a culturally appropriate greeting. Offering a choice of gender-concordant provider.	Ask: “Are there any cultural or family supports you’d like involved today?”
Inquire about traditional healing or beliefs	Exploring the role of traditional bush medicine or community Elders and how they can be integrated	Respect traditional medicine and spirituality without judgment
Explore previous negative healthcare experiences	Acknowledging mistrust due to historical trauma:	Use trauma-informed language: “Many people have had hard experiences with the system. I want to make sure you feel safe here.” “I understand some people have had bad experiences with hospitals in the past. I’d like to make sure you feel safe here.”

Rural Context

Action	Competency Demonstrated	CCE Tip
Offer telehealth, SMS, or remote monitoring where access is limited	Maintains communication infrastructure	Mention in CbD: “Given the distance, I’d set up phone reviews every 2 weeks.”
Adjust plan for postal delays or lack of in-person follow-up	Chooses appropriate communication modes	E.g., Sending SMS reminders for appointments or using a shared care plan app (e.g. My Health Record) when postal access is delayed or unreliable.

Common Issues in the exam:

• Not identifying or addressing patient’s ideas, concerns, and expectations (ICE)
• Poor structuring of consultations or excessive information gathering
• Limited empathy or inadequate rapport in difficult conversations
• Overuse of medical jargon
• Failing to check patient understanding

Example Scenarios:

• Discussing PSA screening with an anxious patient
• Explaining type 2 diabetes diagnosis to a patient with low health literacy
• Addressing vaccine hesitancy in a parent
• Managing an angry patient upset about delayed referrals

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2. Clinical Information Gathering and Interpretation

• Elicits biopsychosocial history from all appropriate sources
• Performs respectful, targeted examinations
• Accurately detects and interprets physical signs
• Selects and interprets investigations appropriately and evidence-based

Aboriginal and Torres Strait Islander context

• Addresses complexity and barriers in health presentations

Rural context

• Adapts to isolated patient needs

Step	Action	How This Demonstrates Competency	CCE Context Tips
1. Prepare and Introduce	Greet the patient, confirm identity, seek consent to take history	Establishes professional rapport and sets a respectful tone	Important in trauma-informed care; ask permission before sensitive questions
2. Elicit Biopsychosocial History	Use structured but patient-centred questioning to explore – biomedical – psychological – social – cultural – functional aspects	Demonstrates comprehensive, holistic data gathering – family support – financial barriers – stress due to job insecurity – limited health literacy	Use “ICE” framework (Ideas, Concerns, Expectations); ask about social determinants
3. Use Collateral Sources if Relevant	Involve carers, medical records, discharge summaries, or other clinicians as appropriate	Gathers history from all appropriate sources	Mention this step in Case-Based Discussion stations for dementia, chronic illness, paediatrics
4. Tailor to Cultural and Linguistic Context	Ask about – health beliefs – interpreter needs – preferred communication style	Demonstrates cultural awareness, builds trust	In ATSI context: use yarning style, acknowledge kinship, avoid direct questioning early
5. Perform (or Describe) Focused Examination	Targeted exam based on presenting complaint, with clear explanation and consent	Conducts respectful, clinically relevant assessments	In CCE: explain what you’d do, what you’re looking for, and potential abnormal findings
6. Interpret Clinical Findings	Accurately describe and contextualise signs and link them to likely diagnoses	Converts physical findings into meaningful diagnostic information	Don’t just name the signs – explain significance (e.g., “bruit suggests turbulent flow from stenosis”)
7. Choose Investigations Rationally	Select tests that are indicated, evidence-based, and appropriate for patient context	Demonstrates efficient, safe, cost-conscious clinical reasoning	Avoid shotgun pathology/imaging; justify each test by pre-test probability
8. Acknowledge Barriers in ATSI Context	Explore access issues, historical trauma, and trust with health system	Ensures culturally safe and effective information gathering	“Have you been able to get to appointments easily?” or “Has anything made it hard to come in?” example: recurrent abdominal pain who has missed multiple appointments—clinician gently explores past trauma, housing insecurity, and transport limitations. Uses narrative-style history taking to reduce power imbalances.
9. Adapt to Rural or Remote Setting	Modify approach based on available resources, transport, or technology	Demonstrates flexibility and context-sensitive practice	Mention use of telehealth, point-of-care tests, shared care with local nurse or RFDS
10. Summarise and Check Understanding	Recap key issues with patient and confirm accuracy	Promotes patient engagement, reduces misunderstandings	Ask: “Have I understood you correctly?” or “Is there anything else important you’d like to add?”

Focus on structured but flexible history domains:

Component	Prompts	Competency Demonstrated
Biomedical	“Can you tell me about the symptoms you’re experiencing?”	Accurately gathers presenting complaint & medical history
Psychological	“How has this been affecting your mood or sleep?”	Includes mental health assessment
Social	“Who do you live with? Is anyone helping you with daily activities?”	Assesses social supports, home situation
Cultural	“Are there any cultural practices or beliefs that you’d like me to consider when planning care?”	Incorporates ATSI health beliefs
Functional	“How has this been impacting your work or daily routine?”	Explores functional limitations
Access Barriers	“Has anything made it hard for you to get to appointments or follow treatment plans?”	Addresses ATSI and rural complexity

Common Issues in the exam:

• Incomplete or unfocused history (e.g., missing red flags, psychosocial history)
• Over-ordering investigations not tailored to case
• Poor justification of physical examination or incorrect technique
• Not synthesising information to guide further steps

Example Scenarios:

• Fatigue in a middle-aged woman (missed depression or sleep apnoea)
• Chest pain in a smoker (missed cardiac red flags or psychosocial context)
• Chronic cough with incomplete occupational history

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3. Diagnosis, Decision-Making, and Reasoning

• Synthesises information in complex cases
• Adjusts diagnosis as new data arises
• Demonstrates diagnostic accuracy and safe reasoning
• Uses hypothesis-driven approach
• Prioritises critical diagnoses (likely, less likely, can’t miss)
• Demonstrates metacognition (reflects on own reasoning)

Aboriginal and Torres Strait Islander context

• Diagnostic strategies enhance outcomes in Aboriginal patients

step	Action	How This Demonstrates Competency	CCE Context Tips
1. Synthesize Information	Integrate history, exam, and investigation findings to form a working diagnosis	Synthesises complex data into logical conclusions	Summarise case aloud: “Key features are… therefore most likely…”
2. Adjust Diagnosis as Data Evolves	Update diagnosis as new symptoms, investigations, or responses to treatment emerge	Adjusts diagnostic reasoning dynamically	In CbD: “Initially suspected X, but worsening labs suggest Y”
3. Demonstrate Diagnostic Accuracy	Use clinical features and prevalence data to narrow differentials appropriately	Accurate and safe diagnostic thinking	Mention red flags, rule out serious pathology first
4. Use Hypothesis-Driven Approach	Apply pattern recognition early, then test hypotheses with focused questions or tests	Structured clinical reasoning	“Given RUQ pain, I’d consider biliary colic first; I’ll ask about meals, fevers…”
5. Prioritise Critical Diagnoses	Categorise differentials: likely, less likely, can’t miss (e.g. ACS in chest pain)	Risk-based prioritisation	Always verbalise “can’t-miss” diagnoses in clinical reasoning
6. Reflect on Own Reasoning (Metacognition)	Recognise cognitive biases (e.g. anchoring) or uncertainty and plan for safety-netting	Demonstrates self-awareness	“I’m mindful I may be anchoring on a musculoskeletal cause—I’ll arrange follow-up”

ATSI Context

• Use culturally sensitive reasoning; consider atypical presentations, holistic views
• “In Aboriginal patients, I would assess broader factors like grief, housing, trauma when evaluating chronic pain or fatigue”

Common Issues in the exam:

• Poor articulation of differentials
• Failure to consider “can’t miss” diagnoses
• Inappropriate reasoning pathways or jumping to diagnosis
• No reflective reasoning (metacognition not demonstrated)

Example Scenarios:

• Abdominal pain in young woman → missed ectopic pregnancy
• Headache in elderly → missed temporal arteritis
• Back pain → didn’t consider spinal cord compression or malignancy

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4. Clinical Management and Therapeutic Reasoning

• Synthesises information in complex cases
• Adjusts diagnosis as new data arises
• Demonstrates diagnostic accuracy and safe reasoning
• Uses hypothesis-driven approach
• Prioritises critical diagnoses (likely, less likely, can’t miss)
• Demonstrates metacognition (reflects on own reasoning)

Aboriginal and Torres Strait Islander context

• Diagnostic strategies enhance outcomes in Aboriginal patients

Step	Action	How This Demonstrates Competency	CCE Context Tips
1. Demonstrate Pharmacological + Non-Pharmacological Knowledge	Offer evidence-based meds and lifestyle changes	Broad therapeutic understanding	“I’d start metformin and also refer for dietitian input”
2. Prescribe Safely	Choose correct drug, dose, duration; consider allergies, renal function, interactions	Safe and rational prescribing	Avoid duplication, adjust for age/CKD, mention PBS if relevant
3. Monitor for Adverse Effects	Plan follow-up for side effects, blood tests, adherence	Monitors risk and promotes safety	“I’ll check renal function in 1 week after starting ACE inhibitor”
4. Tailor to Context and Needs	Modify plan based on values, financial barriers, health literacy	Patient-centred care	“Given cost issues, I’ll use PBS option and avoid combo meds”
5. Involve in Shared Decision-Making	Use teach-back and negotiate: “Here are your options. What matters most to you?”	Promotes autonomy and compliance	Use visual aids or simplified terms to facilitate understanding

• ATSI Context
  • Collaborate with Aboriginal health workers and respect social/cultural priorities
  • “I’d engage the Aboriginal Health Worker and discuss use of community transport”
• Rural Context
  • Coordinate with local nurses, allied health, and visiting specialists
  • “I’ll link with the local nurse practitioner and arrange remote cardiac review”

Common Issues in the exam:

• Management not aligned to diagnosis or guidelines
• No safety netting or unclear follow-up plan
• Failure to consider non-drug interventions
• Not addressing comorbidities or holistic care

Example Scenarios:

• Managing newly diagnosed hypertension without lifestyle advice
• Prescribing antibiotics without explaining side effects or resistance
• Not addressing mental health in a patient with chronic pain

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5. Preventive and Population Health

• Implements screening and prevention for common diseases
• Uses opportunistic and planned health promotion
• Coordinates care across teams and services
• Identifies and responds to emerging public health issues

Aboriginal and Torres Strait Islander context

• Reduces inequalities using evidence-based approaches
• Enhances self-determination through tailored strategies

Rural context

• Delivers and sustains health education
• Minimises access barriers and manages public health risks

Step	Action	How This Demonstrates Competency	CCE Context Tips
1. Implement Screening & Prevention	Use Red Book guidelines to recommend age-appropriate screening	Applies national prevention frameworks	“This patient is due for bowel screening and BP check”
2. Use Opportunistic Health Promotion	Address risk factors even if not main concern (e.g. smoking cessation in skin check visit)	Maximises preventive opportunity	Use brief interventions; offer referrals
3. Coordinate Team-Based Care	Involve other services: dietitian, physio, mental health clinician, pharmacy	Ensures continuity and quality of care	In CbD: “I’d send a shared care plan to the chronic disease nurse”
4. Respond to Public Health Issues	Recognise outbreaks, antimicrobial resistance, or community health concerns	Population-level clinical awareness	“With pertussis in the school, I’d advise prophylaxis and notify public health unit”

• ATSI Context
  • Apply strategies that reduce health inequality and improve cultural safety
  • “I’d use community-led programs like ‘Deadly Choices’ for health literacy”
• Rural Context
  • Offer flexible education, overcome transport or workforce limitations
  • “We’ll arrange home visits for vaccinations via the local community nurse”

Common Issues in the exam:

• Management not aligned to diagnosis or guidelines
• No safety netting or unclear follow-up plan
• Failure to consider non-drug interventions
• Not addressing comorbidities or holistic care

Example Scenarios:

• Managing newly diagnosed hypertension without lifestyle advice
• Prescribing antibiotics without explaining side effects or resistance
• Not addressing mental health in a patient with chronic pain

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6. Professionalism

a) Ethical Practice

• Demonstrates high ethical standards and boundaries
• Open to feedback, reflective, manages critical incidents
• Seeks help for personal health issues

b) Professional Development

• Critically appraises evidence
• Engages in CPD and learning needs assessments
• Participates in audit and quality improvement

Aboriginal and Torres Strait Islander context

• Advocates culturally safe care, equity, and policy understanding

Rural context

• Manages personal/professional role boundaries
• Supports peers facing isolation

Subdomain	Action	How This Demonstrates Competency	CCE Context Tips
Ethical Practice	– Respect confidentiality – declare conflicts of interest – manage dual relationships	Upholds high ethical standards and boundaries	E.g. “I would not prescribe for family; I’d direct them to another provider”
	Reflect on mistakes or adverse events constructively	Open to feedback and critical reflection	“In retrospect, I should’ve safety-netted more clearly—I’ll revise my process”
	Seeks timely support for own health	Ensures fitness to practice	“If I was experiencing burnout, I’d seek GP support and adjust my workload”
Professional Development	Critically appraise new evidence, avoid outdated practices	Demonstrates evidence-based learning	“I’d review the latest ETG or Cochrane before making a decision”
	Engage in CPD and performance review	Identifies and addresses learning gaps	“I regularly reflect after cases and log my CPD hours accordingly”
	Participate in quality improvement	Supports practice improvement and safety	E.g. “We audited diabetic foot screening and improved rates via recall system”

• ATSI Context
  • Advocate for culturally safe care, challenge systemic bias, support Indigenous health initiatives
  • “I’d include cultural safety training in our QI activities and advocate for interpreter funding”
• Rural Context
  • Maintain boundaries where doctor is part of the community; support colleagues facing burnout
  • “I’d debrief with peers regularly and be cautious about dual relationships in a small town”

Common Issues in the exam:

• Breaches of confidentiality or not obtaining informed consent
• Defensive responses to feedback
• Poor reflection on personal biases or professional boundaries
• Unprofessional conduct in documentation or notes

Example Scenarios:

• Managing conflicting requests from separated parents for a child’s care
• Responding to patient dissatisfaction about medical advice
• Managing own distress in a terminal illness disclosure scenario

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7. General Practice Systems and Regulatory Requirements

• Uses IT effectively in consultations
• Maintains accurate records and uses recall systems
• Manages informed consent and confidentiality
• Understands infection control, legal documentation

Aboriginal and Torres Strait Islander context

• Uses MBS/PBS tools for improved outcomes
• Evaluates local health service capacity

Rural context

• Implements efficient practice systems under resource constraints

Step	Action	How This Demonstrates Competency	CCE Context Tips
Use IT Effectively	Use e-scripts, My Health Record, secure messaging	Enhances efficiency and care continuity	“I’d upload the shared care plan to My Health Record for access by all providers”
Accurate Documentation	Write objective, timely, medicolegally sound notes	Supports safe, defensible practice	“I’d document safety-netting and consent discussions in detail”
Informed Consent & Confidentiality	Explain procedures, risks, alternatives; confirm understanding	Manages legal and ethical obligations	“Before performing a biopsy, I’d obtain written consent, discuss bleeding risks”
Infection Control	Use PPE appropriately, follow cleaning protocols	Ensures patient/staff safety	“I’d use droplet precautions and flag patient for infectious risk”

• ATSI Context
  • Use MBS items (e.g. 715 health check) and Aboriginal health funding
  • Improves outcomes through targeted resources
  • “I’d offer a 715 health check and engage with the Aboriginal Medical Service for follow-up”
• Rural Context
  • Adapt systems under constraints (e.g. no onsite nurse, limited recall software)
  • Demonstrates flexibility in low-resource settings
  • “I’d implement a manual recall register if no automated system was available”

Common Issues in the exam:

• Poor documentation (inadequate referral letters or case notes)
• Missed legal documentation requirements (e.g., fitness to drive)
• Failing to use recall systems or follow-up plans
• Breach of privacy in written or verbal communication

Example Scenarios:

• Writing a fitness to drive report for a patient with epilepsy
• Preparing a mental health care plan with inadequate goal setting
• Consent issues in minor procedures or intimate examinations

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8. Procedural Skills

• Demonstrates a wide range of procedural skills suited to practice needs
• Refers when procedures exceed scope

Rural context

• Maintains procedural skills relevant to community needs

Step	Action	How This Demonstrates Competency	CCE Context Tips
Perform Procedural Skills	Execute relevant skills (e.g. suturing, Implanon insertion, joint injection) safely and competently	Matches procedural scope to practice need	Describe key steps and consent process during CCE
Refer Appropriately	Recognise scope of competence; refer for complex procedures	Ensures patient safety and appropriate escalation	“This foreign body removal risks nerve injury, so I’d refer to ENT”

• Rural Context
  • Maintain relevant skills (e.g. skin excisions, emergency management) where no other provider is accessible
  • Meets community needs
  • “I maintain confidence in urgent procedural skills like catheterisation and IUD insertion”

Common Issues in the exam:

• Attempting procedures outside scope or competency
• Failing to gain informed consent
• Not recognising when referral is appropriate

Example Scenarios:

• Performing Implanon insertion with poor aseptic technique
• Incorrect approach to excision of a skin lesion
• Failure to refer for IUD insertion when not credentialled

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9. Managing Uncertainty

• Approaches undifferentiated conditions with structured reasoning
• Uses time safely as a diagnostic tool
• Integrates new information to evolve the diagnosis

Step	Action	How This Demonstrates Competency	CCE Context Tips
Approach Undifferentiated Symptoms	Take broad history, keep open differential	Handles uncertainty safely	“In a patient with fatigue, I’d screen for anaemia, thyroid disease, depression”
Use Time as a Diagnostic Tool	Defer invasive testing where safe; review and observe	Uses watchful waiting judiciously	“Given non-specific symptoms, I’d arrange a 48-hour review before escalating”
Integrate New Information	Update working diagnosis as investigations return	Maintains diagnostic flexibility	“Initial thought was viral URTI, but rising CRP and tenderness suggests peritonsillar abscess”

Common Issues in the exam:

• Over-investigating or premature reassurance
• Ignoring ‘wait and review’ as a diagnostic strategy
• Failing to acknowledge uncertainty with patient

Example Scenarios:

• Unexplained weight loss with no red flags (poor use of time as a tool)
• Recurrent abdominal pain with normal investigations
• Chronic dizziness in older adult

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10. Identifying and Managing the Patient with Significant Illness

• Recognises and manages acute or life-threatening illness early
• Acts decisively while recognising personal limits

Rural context

• Leads in emergencies, liaises with retrieval services

Step	Action	How This Demonstrates Competency	CCE Context Tips
Recognise Acute or Life-Threatening Illness	Identify red flags (e.g. altered GCS, hypotension, chest pain with ECG changes)	Detects and responds to early signs of deterioration	“This is unstable sepsis – I’d activate emergency response and start resuscitation”
Act Decisively, Within Limits	Administer O2, fluids, initial meds, escalate when needed	Shows confidence and awareness of scope	“I’d start IV fluids and antibiotics and call for urgent transfer”
Rural Context – Lead in Emergencies	Coordinate with retrieval services (e.g. RFDS, Retrieval Queensland), delegate roles	Takes leadership and maintains situational awareness	“I’d stabilise with available team and call RSQ for aeromedical transfer”

Common Issues in the exam:

• Failure to identify acute deterioration or red flags
• Overconfidence without escalation
• No emergency action plan or call for help

Example Scenarios:

• Sepsis in elderly patient presenting with non-specific symptoms
• Chest pain with signs of STEMI but delay in escalation
• Child with drowsiness and fever → missed meningitis

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11. Aboriginal and Torres Strait Islander Health

• Applies culturally safe communication
• Integrates Aboriginal health beliefs into care
• Recognises impact of colonisation and systemic disadvantage
• Uses appropriate models (e.g. ACCHS, CTG, ATAPS)
• Collaborates with cultural brokers and Aboriginal health workers

Step	Action	How This Demonstrates Competency	CCE Context Tips
Apply Culturally Safe Communication	Use respectful language, yarning style, avoid medical jargon	Builds trust and cultural safety	“Would you be happy for me to ask some questions about your story?”
Integrate Health Beliefs	Consider traditional medicine, family decision-making, spiritual health	Holistic and culturally competent care	“Are there any traditional practices you find helpful in managing this illness?”
Acknowledge Colonisation/Systemic Disadvantage	Understand intergenerational trauma, historical context, racism in health	Trauma-informed care	“Many people have had difficult experiences with hospitals – I want to make this feel safe for you”
Use Aboriginal Health Models	Engage ACCHS, Close the Gap (CTG) registration, ATAPS	Integrates community-led frameworks	“I’d register under CTG for subsidised access and refer to Aboriginal Health Worker”
Collaborate with Cultural Brokers	Involve Aboriginal Health Workers in care planning and follow-up	Supports continuity and local cultural context	“I’d ask our clinic’s Aboriginal Health Worker to help support follow-up and engagement”

Common Issues in the exam:

• Lack of culturally safe communication
• No consideration of social/cultural determinants
• Ignoring Aboriginal-specific health programs (e.g., CTG, MBS items)

Example Scenarios:

• Discussing diabetes complications with an Aboriginal patient
• Designing a management plan for COPD in an Indigenous community setting
• Not recognising intergenerational trauma or systemic barriers

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12. Rural Health

• Communicates remotely and maintains infrastructure
• Uses locally adapted skills and services
• Demonstrates leadership in rural emergencies
• Implements sustainable public health programs
• Manages workload and supports isolated colleagues

Step	Action	How This Demonstrates Competency	CCE Context Tips
Remote Communication + Infrastructure	Use telehealth, maintain reliable referral and retrieval channels	Ensures care continuity in isolated settings	“I’d use telehealth to consult cardiology and coordinate retrieval if needed”
Locally Adapted Clinical Skills	Maintain skills like skin excisions, suturing, acute care, wound debridement	Meets the procedural needs of rural practice	“In our town, I manage skin cancers due to lack of local dermatology”
Leadership in Rural Emergencies	Lead resus, coordinate limited team, communicate with retrieval	Provides clinical leadership in high-stress rural settings	“I’d stabilise the patient, lead the code, and coordinate handover to aeromedical team”
Implement Public Health Programs	Run sustainable immunisation drives, STI screening, chronic disease management	Contributes to rural community health	“I coordinate annual diabetes screening at the local school and mine site”
Manage Workload + Support Colleagues	Prevent burnout, promote peer support, flexible rostering	Sustains healthcare workforce in rural areas	“We rotate after-hours on-call and check in weekly to support each other’s wellbeing”

Common Issues in the exam:

• Ignoring access barriers or limited local services
• Not identifying local networks/referral options
• Lack of preparedness for procedural or emergency situations

Example Scenarios:

• Telehealth review of a patient with poorly controlled diabetes
• Managing chest pain in a remote town without an ED
• Collaborating with a local community nurse or Aboriginal health worker