CQUniversity Unit Profile.

Overview

As a paramedic working in primary care, you are shifting from a traditional "emergency response" model to a holistic, community-based practitioner model. In the community you may routinely manage older adults experiencing complex, non-linear declines in health. This assessment will develop your skills in 1) navigating the reality of diagnostic shadowing, 2) combating the polypharmacy epidemic, 3) interprofessional governance. 

Ultimately this assessments mimics the professional documentation, analytical workflow and clinical handover skills you will use in primary care to keep vulnerable, multi-morbid people safe, independent and out of the hospital system.

Task Description

Write a professional clinical audit and referral report based on a case scenario provided on Moodle in week three. You must analyse the case file, document your diagnostic findings, audit their complex medication regimen, and design an actionable primary care escalation pathway.  Your report should be divided into three sections:

1. Advanced Clinical Assessment & Diagnostic Profiling (approx. 500 words)

Document and analyse the patient's objective physical and cognitive status. You must show an advanced clinical mastery of geriatric assessment frameworks.

• Cognitive Screening Tools: Document, interpret and present the results of cognitive screening tools. Do not just list scores, analyse the specific cognitive domains impaired (e.g. executive function vs. short-term recall).
• Gait & Frailty Analysis: Document and critically analyse objective mobility metrics alongside a validated frailty score.
• Diagnostic Documentation: Synthesise these findings to justify a clear, evidence based differential diagnosis or diagnostic profile of the patients decline, explicitly ruling out acute triggers.

2. Comprehensive Medication Safety Review (approx. 600 words)

Conduct a rigorous audit of the patient's concurrent prescribed, over the counter and complementary medications.

• Tool Application: Apply an industry standard screening framework to evaluate the patient's full medication list.
• Mechanistic Analysis: Identify and critically analyse medications directly contributing to cognitive impairment, central nervous system depression, or orthostatic hypotension. Detail the exact pharmacological mechanisms causing the clinical decline documented in section one.

3. Referral Letter (approx. 400 words)

Conclude your report with a professional, public-grade referral letter addressed to the patient's primary healthcare provider to coordinate long-term shared care

• Communication Style: Utilise a structured handover framework tailored for an interprofessional medical audience.
• Actionable Strategy: State your definitive clinical concerns clearly. Propose explicit, evidence-based pharmacological recommendations (e.g. specific de-prescribing choices, cross titration steps, or safe therapeutic alternatives) to optimise the patient's cognitive safety.

Level of GenAI use allowed:

Level 2: You may use Al for planning, idea development, and research. Your final submission should show how you have developed and refined these ideas.

This assessment will be graded in accordance with the rubric provided on the units Moodle site.

Marking Rubric Focus

Your submission will be assessed against the following criteria:

• Advanced clinical assessment
• Diagnostic profiling
• Pharmacological audit & synthesis
• Actionable strategy
• Professional referral communication
• Quality of evidence
• Academic & professional literacy
• Referencing skills (feedback only - no numeric grade)

Overview

Advanced clinical practice requires a profound shift from executing protocols to mastering systemic clinical governance, advanced diagnostic safety and clinical scholarship. As health systems in Australia increasingly rely on shared-care and multidisciplinary care models, advanced practice paramedics whether operating in primary care, urgent care or emergency ambulance services occupy a critical role. 

This assessment is directly grounded in the tragic realities of contemporary clinical practice. The NSW Inquest into the death of a 7-year-old highlights a critical vulnerability in modern medicine, the catastrophic failure to identify a high-acuity, rapidly deteriorating patient presenting with seemingly low acuity symptoms within a fragmented health care network. 

Why this matters

• Systemic and Interprofessional Synthesis: Patients do not experience primary health care (General Practice), urgent care and emergency ambulance as isolated events; they experience them as a continuum. As a paramedic or advanced practice paramedic working in primary care, you must look past organisational silos to critically audit how communication failures and cognitive biases (such as anchoring and diagnostic overshadowing) dissolve the interprofessional safety net.
• Acuity Masking: In community, primary and urgent care settings, patients frequently present with ambiguous symptoms. Advanced practice demands the diagnostic maturity to synthesise multi-presentation histories, physiological trajectories and parental concerns, rather than relying on isolated "spot-check" vital signs that can easily be rationalised away.
• Advanced Pharmacotherapeutic Oversight: Prescribing or administering medications at an advanced practice level requires much more than matching a drug to a disease. You must possess the advanced pharmacokinetic and pharmacodynamic knowledge to defend empiric therapies low and high acuity scenarios, while simultaneously auditing how common therapies (such as over-the-counter medicines) can mask severe physiological collapse and mislead clinicians. 
• Clinical Leadership through Scholarship: True clinical leaders do not just change their own practice - they change the system. Preparing your findings as a peer-reviewed journal manuscript models the exact mechanism clinical leaders use to disseminate evidence, influence policy, and drive macro-level safety changes across the healthcare sector. 

Clinical Reality Check: This task is not an academic exercise in finger-pointing. It is a rigorous, forensic exploration of how cognitive biases, pharmacological masks, and system gaps interact to cause fatal outcomes. Your objective is to use your new knowledge and advanced clinical reasoning skills to construct the structural, clinical and communication guardrails that will prevent these failures from ever happening again. 

Task Instructions

You are an advanced practice paramedic submitting a case commentary for publication in a peer-reviewed international health journal, based on a coronial report (provided on Moodle).

A case commentary differs from a case report. It requires you to:

• Engage critically and analytically with the case
• Situate the case within contemporary practice evidence and practice standards
• Offer expert interpretation, critique, and recommendations

Your writing should reflect advanced clinical reasoning, independent judgement and awareness of system level influences on patient care as expected for Advanced Practice Clinicians. 

Structure & Requirements

Your case commentary should be structured as follows:

Title

• Provide a concise, informative title reflecting the clinical and analytical focus of your commentary.

Introduction (approx. 200 words)

• Introduce the significance of the case
• Situate it withing primary care and paramedic practice in this setting
• Clearly state the purpose and focus of your commentary

Case Framing (approx. 300 words)

Provide a focused clinical framing (not a descriptive summary). You should:

• Identify key clinical problems and pathophysiology
• Highlight risk factors and clinical priorities
• Identify areas of uncertainty or diagnostic complexity

Critical Analysis of Care (approx. 600 words)

Provide a critical appraisal of the care provided. You must:

• Identify and justify instances of substandard or suboptimal practice
• Support your analysis with clinical guidelines and contemporary evidence

Your discussion should include:

• Clinical reasoning and potential cognitive biases
• Recognition (or failure to recognise) deterioration
• Communication, documentation, and escalation
• System-level contributors (e.g. protocols, resourcing, organisational factors)

Important: You must demonstrate awareness of hindsight bias and avoid purely retrospective judgement.

Evaluation of Clinical Management (approx. 500 words)

Critically evaluate the management of the case using advanced clinical reasoning. You should:

• Consider alternative management approaches
• Justify what should have been prioritised and why
• Discuss trade-offs between:
  • Risk
  • Benefit
  • Contextual constraints (e.g. access to care, geographical location, out of hospital environment)
• Where relevant, compare across care contexts (e.g. primary care, urgent care, emergency department, emergency ambulance, extended care paramedic etc.).

Proposed Management Approach (approx. 800 words)

Present a defensible, evidence-based management approach for this case. Your discussion should:

• Reflect paramedic scope of practice and real-world constraints
• Include:
  • Assessment and initial management
  • Escalation and referral decisions
  • Safety-netting and follow-up

You must demonstrate:

• Clinical prioritisation
• Consideration of uncertainty and patient risk

Discussion & Implications for Practice (approx. 200 words)

• Identify key clinical and system-level lessons
• Discuss implications for:
  • Paramedic practice
  • Patient safety
  • Multidisciplinary care

Conclusion including Critical Reflection on Coroner's Findings (approx. 200 words)

• Critically evaluate the coronial conclusions
• Identify:
  • Strengths
  • Limitations
  • Any assumptions or gaps

Pharmacological reasoning must be integrated throughout your commentary, not presented as a separate section. You should:

• Justify medication use within your analysis and proposed management
• Consider: Indications and contraindications
• Mechanisms of action (where relevant to decision-making)
• Patient-specific risk factors
• Timing and sequencing of therapy

Evidence Requirements

You must:

• Use 12-15 high-quality contemporary sources as a minimum
• Include
  • Peer-reviewed literature
  • Evidence Informed Guidelines

Your work should demonstrate critical synthesis of evidence, not descriptive use of sources.

Important Notes

• This is a case commentary, not a case summary or narrative report
• High-quality submissions will:
  • Demonstrate independent, critical thinking
  • Integrate pharmacology across the discussion
  • Consider both individual and system contributors to care
  • Explicitly address risk, uncertainty, and complexity in decision-making
    

Level of GenAI use allowed:

Level 2: You may use Al for planning, idea development, and research. Your final submission should show how you have developed and refined these ideas

This assessment will be graded in accordance with the rubric provided on the units Moodle site.

Marking Rubric Focus

Your submission will be assessed against the following criteria:

• Depth and quality of critical analysis
• Ability to synthesise and apply evidence
• Demonstration of advanced clinical reasoning and judgement
• Integration of pharmacology into clinical decision making
• Quality of review and recommendations
• Consideration of uncertainty, risk and system factors
• Quality of evidence
• Clarity, structure and academic writing quality
• Referencing skills (feedback only - no numeric grade)

Overview

This assessment requires students to demonstrate advanced, integrated paramedic practice through a series of structured simulated clinical encounters reflective of low-acuity and chronic care presentations. Students will apply knowledge, critical thinking, and clinical judgement to perform advanced physical assessments, synthesise clinical findings, and formulate evidence-informed management plans. Students will be required to implement appropriate treatment strategies, including procedural skills, and demonstrate safe, contextually appropriate integration of pharmacological therapies into patient care. Performance will be evaluated on a pass/fail basis, with emphasis on autonomy, adaptability, and safety in complex yet common clinical scenarios in primary and urgent care, reflecting the capability to operate with initiative and accountability in professional practice.

Level of GenAI use allowed:

Level 1: You must not use AI at any point during the assessment. You must demonstrate your core skills and knowledge

This assessment will be graded in accordance with the marking guide provided on the units Moodle site.

Assessment Criteria Guide

Students must demonstrate all criteria at a safe and competent level to achieve a Pass; a maximum of two attempts is permitted. 

To achieve a Pass, students must demonstrate safe and competent:

• Physical exam technique
• Clinical reasoning / decision making
• Treatment decisions
• Procedural skills
• Pharmacology integration

Pass = Safe and competent AND no critical errors

Critical Fail Triggers

• Missed obvious red flag/s
• Unsafe technique (e.g. harmful exam or procedure)
• Unsafe discharge from care
• Dangerous medication choice
• Inappropriate treatment
• Missed escalation need

The 72-hour grace period does not apply to this assessment.