- BSBMED301B - Interpret and apply medical terminology appropriately
Assessor Resource
BSBMED301B
Interpret and apply medical terminology appropriately
Assessment tool
Version 1.0
Issue Date: December 2023
This unit applies to individuals who are skilled operators and apply a broad range of competencies in various medical administration contexts. They may exercise discretion and judgment using appropriate knowledge to provide technical advice and support to a team.
This unit describes the performance outcomes, skills and knowledge required to understand and respond to instructions; to carry out routine tasks and communicate with a range of internal/external clients in a medical environment; and to use appropriate advanced medical terminology.
No licensing, legislative, regulatory or certification requirements apply to this unit at the time of endorsement.
You may want to include more information here about the target group and the purpose of the assessments (eg formative, summative, recognition)
Employability Skills
This unit contains employability skills.
Evidence Required
List the assessment methods to be used and the context and resources required for assessment. Copy and paste the relevant sections from the evidence guide below and then re-write these in plain English.
The Evidence Guide provides advice on assessment and must be read in conjunction with the performance criteria, required skills and knowledge, range statement and the Assessment Guidelines for the Training Package. | |
Overview of assessment | |
Critical aspects for assessment and evidence required to demonstrate competency in this unit | Evidence of the following is essential: using medical terminology in written and verbal communication identifying and appropriately using abbreviations for medical terms and associated processes managing own learning to maintain knowledge of up-to-date medical terminology knowledge of relevant legislation from all levels of government that impacts on business operations, codes of practice and national standards. |
Context of and specific resources for assessment | Assessment must ensure: access to an actual workplace or simulated environment access to office equipment and resources examples of documentation and resources. |
Method of assessment | A range of assessment methods should be used to assess practical skills and knowledge. The following examples are appropriate for this unit: direct questioning combined with review of portfolios of evidence and third party workplace reports of on-the-job performance by the candidate review of authenticated documents from the workplace or training environment analysis of responses to case studies and scenarios demonstration of techniques observation of presentations oral or written questioning observation of performance in role plays review of written communication with patients for use of appropriate medical terminology oral or written questioning to assess knowledge of workplace emergencies, risks and hazards assessment of documentation. |
Guidance information for assessment | Holistic assessment with other units relevant to the industry sector, workplace and job role is recommended, for example: other general administration or medical services administration units. |
Submission Requirements
List each assessment task's title, type (eg project, observation/demonstration, essay, assingnment, checklist) and due date here
Assessment task 1: [title] Due date:
(add new lines for each of the assessment tasks)
Assessment Tasks
Copy and paste from the following data to produce each assessment task. Write these in plain English and spell out how, when and where the task is to be carried out, under what conditions, and what resources are needed. Include guidelines about how well the candidate has to perform a task for it to be judged satisfactory.
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Required skills |
literacy skills to interpret policies, signs and instructions and to use correct spelling, grammar and punctuation learning skills to research and increase own knowledge of medical terminology communication skills to understand, clarify and explain instructions and procedures. |
Required knowledge |
medical terminology, including the fundamental word structure used in medical terms basic systems of the body organisational documentation and recording requirements source of information relating to medical terminology key provisions of relevant legislation from all levels of government that affects business operations, codes of practice and national standards, such as: anti-discrimination legislation ethical principles privacy laws Freedom of Information Act. |
The range statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance. Bold italicised wording, if used in the performance criteria, is detailed below. Essential operating conditions that may be present with training and assessment (depending on the work situation, needs of the candidate, accessibility of the item, and local industry and regional contexts) may also be included. | |
Written and oral instructions may include: | diary entries drugs orders instructions for postoperative care notices occupational health and safety (OHS) signs and instructions patient notes referrals routine reports telephone calls test results theatre lists verbal instructions |
Medical terminology may include: | abbreviations for medical and pharmacological terms (e.g. BCG, HRT, IVP, tab, ante, ung) causes to changes in the systems of the body (e.g. changes to the musculo-skeletal system may include inflammation due to repeated strain on the system) common medical conditions including illnesses, injuries and diseases departments/sections in a hospital health insurance terminology interrelated functions of the body, locations and diseases (e.g. functions of the skeletal system, locations of skeletal injuries, skeletal diseases knowledge of medical specialties and the names and titles of doctors working in specialist fields medical conditions medical equipment and instruments medical investigations and procedures Medicare terminology medications referrals terms to describe onset and/or nature of disease |
Policies and procedures may include: | abiding by local, state/territory and commonwealth legislation accessing and updating files cleanliness and hygiene correspondence format emergency procedures following instructions information specific to the enterprise office practice manual OHS Royal Australian College of General Practitioners (RACGP) Code of Practice for the Management of Health Information in General Practice RACGP Entry Standards for General Practices telephone protocol recording information security, confidentiality and privacy procedures |
Clarification may be sought from: | drug and prescription information sources/databases experienced staff member/s medical dictionary office practice manual relevant handbook supervisor |
Routine tasks may include: | answering patient enquiries contributing to meetings dealing with patient complaints entering patient details into computer system filing patient notes maintaining information to assist patients maintaining patient information maintaining reception area, waiting room, consultation room ordering stock (e.g. stationery, medical supplies) preparing medical equipment preparing reports processing correspondence producing a range of complex medical documents (e.g. patient history, case report) providing information to patients receiving and making telephone calls receiving visitors and patients recording information storing and maintaining security of drugs word processing |
Oral communication may include: | answering routine telephone enquiries communicating with a range of medical/hospital professionals on patient related matters confirming appointments dealing with difficult patients/customers paging staff reporting to staff at meetings transferring calls verbal instructions |
Written communication may include: | appointment diaries, cards case reports complex correspondence to a range of medical/hospital professionals on patient related matters forms letters memoranda minutes patient histories patient history questionnaires patient records telephone messages |
Designated person may include: | doctor practice manager supervisor |
Copy and paste from the following performance criteria to create an observation checklist for each task. When you have finished writing your assessment tool every one of these must have been addressed, preferably several times in a variety of contexts. To ensure this occurs download the assessment matrix for the unit; enter each assessment task as a column header and place check marks against each performance criteria that task addresses.
Observation Checklist
| Tasks to be observed according to workplace/college/TAFE policy and procedures, relevant legislation and Codes of Practice | Yes | No | Comments/feedback |
|---|---|---|---|
| Receive, interpret and document written and oral instructions using medical terminology | |||
| Use checklists where appropriate | |||
| Ensure own understanding of abbreviations for specialised medical terminology and associated processes | |||
| Ensure own understanding of and adhere to, the policies and procedures of the enterprise | |||
| Seek clarification when necessary | |||
| Use medical terminology correctly in the completion of routine tasks | |||
| Seek assistance from supervisor or experienced staff member as required | |||
| Use appropriate medical terminology as directed, in oral communication with patients, fellow workers and health professionals | |||
| Use appropriate medical terminology as directed, in written communication with patients, fellow workers and health professionals | |||
| Present written communication to a designated person for verification if required | |||
| Spell and pronounce medical terminology correctly |
Forms
Assessment Cover Sheet
BSBMED301B - Interpret and apply medical terminology appropriately
Assessment task 1: [title]
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I declare that the assessment tasks submitted for this unit are my own work.
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Result: Competent Not yet competent
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Assessment Record Sheet
BSBMED301B - Interpret and apply medical terminology appropriately
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Assessment task 1: [title] Result: Competent Not yet competent
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Feedback to student:
Overall assessment result: Competent Not yet competent
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