Continuity of care and the paediatric medical home

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Target exams

Red flags

• No named medical home or usual clinician for a child with medical complexity
• Open-loop specialty referrals with no result or plan returned
• Repeated ED or hospital use without primary-care loop closure
• Conflicting care plans, unreconciled medicines or missing emergency information form
• Caregiver carrying unpaid full-time coordination with exhaustion or unsafe gaps
• Adolescent with chronic disease approaching adult age without transition plan
• Foster or kinship placement change with incomplete records and no medical home assigned

Life stages

Care settings

Clinical exam formats

Board mappings

• General and Community Paediatrics
• Current 2026 PREP curriculum — Learning Objective 1.2.1: Communicate with a child or young person in a way which is appropriate to the position of that child within their own culture
• Current 2026 PREP curriculum — Learning Objective 1.2.2: Communicate with parents or carers
• Renewed curriculum for first-year trainees from 2027 — Learning goal 5: Clinical assessment – essential general paediatrics
• Renewed curriculum for first-year trainees from 2027 — Learning goal 6: Clinical management – essential general paediatrics
• Renewed curriculum for first-year trainees from 2027 — Learning goal 12: Communication with patients, families, and health professionals
• Renewed curriculum for first-year trainees from 2027 — Learning goal 14: Regional, rural, and remote paediatric care
• Renewed curriculum for first-year trainees from 2027 — Learning goal 15: Essential general paediatrics
• Clinical Applications
• Long Cases
• Short Cases
• 2. Professional skills and knowledge: Communication
• 4. Professional skills and knowledge: Patient management
• 6. Leadership and team working
• 7. Patient safety, including safe prescribing
• General Paediatrics: Assumes the role of Acute Paediatric Team Leader, liaising with primary care services and other hospital and community specialist teams to effectively manage and coordinate patient flow, staffing, safety and quality in the paediatric acute assessment and inpatient units
• Foundation of Practice (FOP)
• Applied Knowledge in Practice (AKP)
• History
• Communication
• Clinical
• General Pediatrics Content Outline — Domain 1: Preventive Pediatrics/Well-Child Care
• General Pediatrics Content Outline — Domain 24: Patient Safety, Quality Improvement, and Research Methods
• General Pediatrics EPA 8: Executing Clinical Handovers Within or Across Settings
• General Pediatrics EPA 10: Leading Interprofessional Teams to Provide Collaborative, Family-Centered Care
• General Pediatrics EPA 11: Promoting Equitable Care at the Level of Each Individual Patient and the Population to Address Racism and Other Contributors to Health Inequities
• Systems-Based Practice 3: System Navigation for Patient Centered Care – Coordination of Care
• Systems-Based Practice 4: System Navigation for Patient-Centered Care – Transitions in Care
• Interpersonal and Communication Skills 1: Patient- and Family-Centered Communication
• Interpersonal and Communication Skills 2: Interprofessional and Team Communication
• Interpersonal and Communication Skills 3: Communication within Health Care Systems
• Patient Care 5: Patient Management
• Collaborator
• Leader
• Health Advocate
• Pediatrics: Foundations EPA #10 — Transferring clinical information between health care providers during handover
• Pediatrics: Foundations EPA #11 — Coordinating transitions of care for non-complex pediatric patients
• Pediatrics: Core EPA #11 — Coordinating transitions of care for patients with medical or psychosocial complexity