- BSBMED301B - Interpret and apply medical terminology appropriately
Interpret and apply medical terminology appropriately
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)
This unit contains employability skills.
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.
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)
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.
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.
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:
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:
instructions for postoperative care
occupational health and safety (OHS) signs and 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 equipment and instruments
medical investigations and procedures
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
information specific to the enterprise
office practice manual
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
security, confidentiality and privacy procedures
Clarification may be sought from:
drug and prescription information sources/databases
experienced staff member/s
office practice manual
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
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
storing and maintaining security of drugs
Oral communication may include:
answering routine telephone enquiries
communicating with a range of medical/hospital professionals on patient related matters
dealing with difficult patients/customers
reporting to staff at meetings
Written communication may include:
appointment diaries, cards
complex correspondence to a range of medical/hospital professionals on patient related matters
patient history questionnaires
Designated person may include:
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.
|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|
Assessment Cover Sheet
BSBMED301B - Interpret and apply medical terminology appropriately
Assessment task 1: [title]
I declare that the assessment tasks submitted for this unit are my own work.
Result: Competent Not yet competent
Feedback to student
Assessment Record Sheet
BSBMED301B - Interpret and apply medical terminology appropriately
Assessment task 1: [title] Result: Competent Not yet competent
(add lines for each task)
Feedback to student:
Overall assessment result: Competent Not yet competent