Models for individual practice

Scope of clinical practice: RDM-p

The scope and nature of clinical practice is summarised by Norfolk’s ‘RDM-p’ model, which incorporates relationship, diagnostics, management and professionalism.

  • Relationship’ with patients, relatives and carers, professionals and even members of the public are central to clinical work and depend on good communication skills, and other attributes such as empathy, which leads to trust.
  • Diagnostics’ refers to gathering, interpreting and prioritising information to decision-making, which includes the clinical diagnostic process, but also more widely to decisions we make in day-to-day practice. The cognitive processes at each stage of the ‘diagnostic journey’ determine the accuracy and safety of our decision-making.
  • Management’ is primarily about how effectively we tackle work processes and tasks, how efficiently and reliably we carry out our responsibilities – whether administrative activities such as dealing with prescriptions, tests results and correspondence, or conducting a consultation, or dealing with multiple (sometimes conflicting) priorities. Management is also about monitoring ourselves effectively, maintaining both our performance and our health.
  • Professionalism is the glue that binds relationship, diagnostics and management together. It defines our commitment to best practice, with an emphasis on showing respect for people, acting responsibly and demonstrating ethical and moral behaviour.

Causes of poor practice: SKIPE

In the SKIPE model, skills and knowledge form the bedrock of competence, but their application can be affected by other internal factors such as such as attitudes, personality and health, or external factors such as the work or non-work environment.

Improvement implies that we assess our strengths and weaknesses in a systematic way. These models, RDM-p and SKIPE enable us to consider our strengths and weaknesses more broadly and thus to build on our strengths and address our weaknesses.