CCE-CE-012

Case ID: CCE-2025-003
Case Name: Lisa Thompson
Age: 32
Gender: Female
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: X30 (Female genital check-up), X37 (Pap smear), X83 (Vaginal discharge)

COMPETENCY OUTCOMES

Competency DomainCompetency Element
1. Communication and Consultation Skills1.1 Engages the patient to understand their concerns and expectations.
1.2 Provides clear and sensitive explanations about examination and investigations.
1.5 Negotiates a shared management plan.
2. Clinical Information Gathering and Interpretation2.1 Takes a thorough sexual and reproductive history.
2.2 Identifies red flags and risk factors for sexually transmitted infections (STIs) and gynaecological conditions.
3. Diagnosis, Decision-Making and Reasoning3.1 Determines the appropriate investigations based on the patient’s history.
3.2 Formulates an appropriate differential diagnosis.
4. Clinical Management and Therapeutic Reasoning4.1 Develops an appropriate screening and management plan.
4.3 Provides guidance on contraception, STI prevention, and reproductive health.
5. Preventive and Population Health5.1 Ensures routine cervical screening and health promotion.
5.3 Provides education on self-examinations and preventive care.
6. Professionalism6.1 Ensures sensitive and respectful communication regarding intimate health.
7. General Practice Systems and Regulatory Requirements7.1 Ensures appropriate documentation and consent for intimate examinations.
9. Managing Uncertainty9.2 Recognises when further assessment or referral is needed.
10. Identifying and Managing the Patient with Significant Illness10.1 Identifies symptoms requiring urgent gynaecological referral.

CASE FEATURES

  • Addressing patient concerns about cervical screening discomfort and results.
  • Routine female genital check-up, including cervical screening test (CST).
  • Concerns about mild vaginal discharge, requiring assessment of infection vs normal physiology.
  • Opportunity for health promotion, including STI screening, contraception, and menstrual health discussions.
  • Ensuring patient comfort during a sensitive consultation.

INSTRUCTIONS

You have 15 minutes to complete the tasks for this case.

You should treat this consultation as if it is face-to-face.

You are not required to perform an examination.

A patient record summary is provided for your information.

Perform the following tasks:

  1. Take an appropriate history
  2. Outline the differential diagnosis and key investigations required.
  3. Provide management advice
  4. Address any concerns the patient may have

SCENARIO

Lisa Thompson is a 32-year-old woman who presents to your clinic for a routine female genital check-up, including her cervical screening test (CST). She mentions that she has had a slight increase in vaginal discharge over the past few months but has no itching, pain, or odour. Lisa is in a long-term relationship with a male partner and is not currently using contraception, as she is planning to conceive in the next year. She has not had an STI screen in over five years and is unsure if she needs one. She wants to make sure everything is healthy before trying for a pregnancy and wants advice on what other tests she may need.

PATIENT RECORD SUMMARY

Patient Details

Name: Lisa Thompson
Age: 32
Gender: Female
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

  • No known drug allergies

Medications

  • Nil regular

Past History

  • No significant medical conditions

Social History

  • Works full-time as a school teacher
  • Non-smoker, drinks occasionally

Family History

  • No history of gynaecological cancers

Vaccination and Preventive Activities

  • The last CST was normal (6 years ago)
  • Completed HPV vaccination series

ROLE PLAYER INSTRUCTIONS

Just like a consultation with a doctor, the candidate will ask you a series of questions.
The OPENING LINE is always to be said exactly as written. This is the only part of the script
which will be the same for all candidates. Where the candidate goes after the opening line is
up to them.

The remainder of the information is to be given based on the questions asked by the
candidate.

The information in the following script are core pieces of information. The core pieces of
information will not necessarily follow the order in the script but should be given when cued
by the candidate’s question.

GENERAL INFORMATION can be given relatively freely. After the opening line, most
candidates will ask an open question like “Can you tell me more about that?” You can provide
the GENERAL INFORMATION in response to that sort of question.

SPECIFIC INFORMATION should only be given when the candidate asks a relevant question.
Candidates don’t need to ask for all the information in the SPECIFIC INFORMATION section,
but all the relevant information is given there should they want to.

Each line or dot point in the SPECIFIC INFORMATION section is an appropriate chunk of
information which can be provided to the candidate when asked a relevant question.

Do not give extra information than asked.

Do not provide details which are not given in the information chunks (i.e.: do not elaborate
or ad-lib).

If the candidate asks a question that is not given in the script, the best way to respond is with
a generic response indicating there is no problem. For example:

Candidate: “How many hours do you sleep?”
Response: “I’m sleeping fine.” / “I don’t have any concerns about my sleep.”

The case may have specific QUESTIONS to ask the candidate. You can start asking the
QUESTIONS if the candidate asks about your ideas or concerns or questions.

Ask the other questions in a conversational way. You do not need to ask all the questions. The
aim should be to ask most of the questions but without interrupting the candidate.

The Patient Record Summary is also included. This is not part of the script but is included for
your general information.

If you need help in understanding any of the medical information in the script, ask the College
examiner who will be with you, and they can help to explain the terms or the conditions.

Opening Line

“Hi Doctor, I’m here for my regular women’s health check, and I wanted to make sure everything is okay before we try for a baby.”

General Information

(Provide this information freely if the candidate asks open-ended questions such as “Tell me more about your concerns.”)

  • You feel well overall but want reassurance that everything is normal.
  • You’ve noticed a slight increase in vaginal discharge over the past few months, but no odour, itching, or pain.
  • You have regular periods, about 28–30 days apart, lasting four to five days with no heavy bleeding or pain.

Specific Information

(Only provide if the candidate asks directly.)

Background Information

  • You haven’t had an STI screen in years and are unsure if it’s needed.
  • You had your last cervical screening test (CST) three years ago, and it was normal.
  • You are planning to start trying for a baby in the next year and want to make sure everything is in order.
  • You don’t take any regular medications and haven’t started prenatal vitamins yet.

Concerns About the Cervical Screening Test

  • You’re nervous about the test because you’ve heard that HPV can cause cancer.
  • You don’t understand how HPV testing works and want more information.
  • You’re worried that if you test positive for HPV, you might not be able to have a baby.
  • You had a bad experience with a Pap smear years ago, where it was uncomfortable, and you felt rushed and embarrassed.
  • You’ve read conflicting advice online about whether cervical screening is necessary if you’re in a monogamous relationship.

Sexual and Reproductive History

  • You’ve been in a monogamous relationship with your male partner for six years.
  • You haven’t had an STI test since your early 20s and never had symptoms of an infection.
  • You have never had an abnormal CST or any gynaecological procedures.
  • You have no pain with intercourse, no spotting after sex, and no abnormal bleeding.

Pregnancy and Preconception Concerns

  • You are excited but also nervous about trying for a baby.
  • You’re not sure if you need any tests before pregnancy.
  • You haven’t started taking folic acid because you weren’t sure when to start.
  • You haven’t had a recent blood test and wonder if anything needs checking.
  • You are not sure if your discharge is normal or if it could affect fertility.

Lifestyle and General Health

  • You exercise a few times a week, mainly yoga and walking.
  • You drink alcohol occasionally but are willing to cut back before pregnancy.
  • You don’t smoke or use recreational drugs.
  • Your weight is stable, and you haven’t had any major health concerns.

Questions for the Candidate

(Ask these naturally in response to the candidate’s explanations.)

  1. “Do I need an STI test if I’ve been in a monogamous relationship?”
  2. “What exactly does the cervical screening test check for?”
  3. “If I have HPV, does that mean I’ll get cancer?”
  4. “What else should I do before trying for a baby?”
  5. “Is this discharge normal, or could it be an infection?”
  6. “Do I need a blood test before pregnancy?”
  7. “Is there anything I should avoid when trying to conceive?”
  8. “If I’ve had the HPV vaccine, do I still need cervical screening?”

Emotional Cues and Body Language

  • You appear mildly anxious about the cervical screening test and HPV testing.
  • You are curious and engaged when discussing pre-pregnancy health.
  • You seem relieved if the doctor reassures you and explains things clearly.
  • If the candidate is empathetic and supportive, you become more relaxed and open.
  • You become defensive or uncomfortable if the doctor pushes too hard about STI testing without a clear explanation.

Final Notes for the Role-Player

  • You appreciate clear, simple explanations about the cervical screening test and HPV.
  • You want to be reassured that HPV is common and manageable.
  • You prefer a patient and gentle approach to discussions about intimate health.
  • You are happy to follow medical advice, but only if the reasoning is well explained.
  • If the candidate acknowledges your concerns and provides a plan, you feel reassured and ready to proceed with the check-up.

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take an appropriate history, including sexual health, menstrual history, and symptoms.

The competent candidate should:

  • Elicit a detailed menstrual history, including cycle regularity, duration, flow, pain, and intermenstrual or postcoital bleeding.
  • Assess vaginal discharge characteristics (colour, consistency, odour, associated symptoms) to differentiate between physiological and pathological causes.
  • Take a thorough sexual health history, covering:
    • Number of lifetime partners
    • Relationship status and monogamy
    • History of STIs, previous screening, and symptoms
    • Condom and contraception use
  • Screen for red flags, such as:
    • Postcoital or intermenstrual bleeding
    • Pelvic pain or dyspareunia
    • Unintentional weight loss
    • Recent new sexual partner or high-risk behaviours
  • Assess preconception health, including lifestyle factors (smoking, alcohol, folic acid intake).

Task 2: Explain the purpose and process of a female genital check-up, including a cervical screening test.

The competent candidate should:

  • Explain the purpose of cervical screening:
    • Detects HPV and pre-cancerous cervical changes
    • Recommended every 5 years for women aged 25–74
    • Still necessary even if vaccinated against HPV
  • Describe the procedure in simple terms:
    • Use of a speculum to visualise the cervix
    • Gentle collection of cells from the cervix using a soft brush
    • Mild discomfort but should not be painful
  • Address common concerns:
    • A positive HPV result does not mean cancer
    • Results help guide monitoring or further testing
    • If abnormal, follow-up with repeat testing, colposcopy, or treatment
  • Explain other components of a genital check-up, including STI screening, vaginal swabs, and preconception tests if indicated.

Task 3: Provide management advice regarding the patient’s concerns, including investigation and follow-up.

The competent candidate should:

  • Reassure the patient that her symptoms are likely physiological, but further assessment is warranted.
  • Recommend investigations as needed, including:
    • Cervical Screening Test if due
    • High vaginal swab if bacterial vaginosis or candidiasis suspected
    • STI screening (chlamydia, gonorrhoea, HIV, syphilis) based on risk factors
    • Preconception blood tests (rubella, varicella, iron studies, thyroid function)
  • Discuss management based on findings:
    • If normal discharge, reassure and advise hygiene measures
    • If infection, provide appropriate antibiotics or antifungals
    • If abnormal CST, arrange colposcopy referral
  • Encourage preconception care, including folic acid supplementation and lifestyle modifications.

Task 4: Address any concerns the patient may have about the examination or test results.

The competent candidate should:

  • Acknowledge and validate concerns about discomfort, embarrassment, and fear of results.
  • Explain that HPV is common and does not always cause cervical cancer.
  • Provide clear information on what happens if an abnormal result is detected.
  • Offer options to improve comfort, such as a smaller speculum or adjusting positioning.
  • Ensure informed consent and offer the option to defer if the patient is anxious.
  • Discuss follow-up, ensuring results are communicated sensitively and timely.

SUMMARY OF A COMPETENT ANSWER

  • Comprehensive history covering menstrual, sexual, and preconception health.
  • Clear explanation of cervical screening, its purpose, and how HPV is managed.
  • Evidence-based management plan, including appropriate investigations and lifestyle advice.
  • Sensitive and patient-centred communication, addressing anxieties about the test.
  • Ensures follow-up and continuity of care.

PITFALLS

  • Failing to identify red flag symptoms, such as postcoital bleeding or pelvic pain.
  • Overlooking STI screening, particularly in a patient with long intervals since last testing.
  • Providing inadequate explanation of cervical screening, causing unnecessary anxiety.
  • Neglecting preconception care, missing an opportunity for early health optimisation.
  • Not ensuring patient comfort, leading to poor engagement and reluctance for future screening.

REFERENCES

MARKING

Each competency area is on the following scale from 0 to 3.

☐ Competency NOT demonstrated
☐ Competency NOT CLEARLY demonstrated
☐ Competency SATISFACTORILY demonstrated
☐ Competency FULLY demonstrated

1. Communication and Consultation Skills

1.1 Communication is appropriate to the person and the sociocultural context.
1.2 Engages the patient to gather information about their symptoms, ideas, concerns, and expectations.
1.5 Negotiates a shared management plan.

2. Clinical Information Gathering and Interpretation

2.1 Takes a thorough sexual and reproductive history.
2.2 Identifies red flags and risk factors for STIs and gynaecological conditions.

3. Diagnosis, Decision-Making and Reasoning

3.1 Determines the appropriate investigations based on the patient’s history.
3.2 Formulates an appropriate differential diagnosis.

4. Clinical Management and Therapeutic Reasoning

4.1 Develops an appropriate screening and management plan.
4.3 Provides guidance on contraception, STI prevention, and reproductive health.

5. Preventive and Population Health

5.1 Ensures routine cervical screening and health promotion.
5.3 Provides education on self-examinations and preventive care.

6. Professionalism

6.1 Ensures sensitive and respectful communication regarding intimate health.

7. General Practice Systems and Regulatory Requirements

7.1 Ensures appropriate documentation and consent for intimate examinations.

9. Managing Uncertainty

9.2 Recognises when further assessment or referral is needed.

10. Identifying and Managing the Patient with Significant Illness

10.1 Identifies symptoms requiring urgent gynaecological referral.

Competency at Fellowship Level

☐ CLEARLY BELOW STANDARD
☐ BELOW EXPECTED STANDARD
☐ BORDERLINE
☐ AT EXPECTED STANDARD
☐ ABOVE STANDARD