Case ID: MH-ANX-003
Case Name: Emily Dawson
Age: 15 years
Gender: Female
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: P01 – Feeling anxious/nervous/tense, P74 – Anxiety disorder/anxiety state

COMPETENCY OUTCOMES

Competency Domain	Competency Element
1. Communication and Consultation Skills	1.1 Communicates effectively and empathetically to establish rapport 1.4 Engages the adolescent in a confidential and supportive manner
2. Clinical Information Gathering and Interpretation	2.1 Takes a thorough history, including psychosocial and school-related stressors 2.3 Identifies signs and symptoms of anxiety and comorbid mental health conditions
3. Diagnosis, Decision-Making and Reasoning	3.1 Differentiates between normal stress, generalised anxiety disorder, and other mental health conditions
4. Clinical Management and Therapeutic Reasoning	4.3 Develops an individualised management plan, including psychological interventions and lifestyle modifications
5. Preventive and Population Health	5.2 Identifies risk factors for adolescent mental health conditions, including school stress, family conflict, and social media use
6. Professionalism	6.2 Ensures confidentiality while managing parental expectations appropriately
7. General Practice Systems and Regulatory Requirements	7.4 Provides appropriate referrals (e.g., mental health care plan, school counsellor)
9. Managing Uncertainty	9.2 Ensures appropriate follow-up and monitoring of anxiety symptoms
10. Identifying and Managing the Patient with Significant Illness	10.1 Identifies signs of severe anxiety or potential self-harm risk and escalates care accordingly

CASE FEATURES

Adolescent female presenting with persistent anxiety symptoms
Concerns about school performance, social pressures, and excessive worrying
Symptoms affecting sleep, concentration, and social interactions
Parental involvement and need for confidentiality considerations
No known self-harm, but risk assessment required
Potential need for psychological and pharmacological management

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:

Take a focused psychosocial history
Assess the severity of anxiety symptoms
Explain your diagnosis and management plan
Provide education and support

SCENARIO

Emily Dawson, a 15-year-old girl, has come to your clinic with her mother, who is worried that Emily has been stressed, irritable, and not sleeping well for the past few months. Her mother is concerned that she is falling behind in school and avoiding social activities. When you speak to Emily alone, she admits that she feels anxious most of the time, especially about schoolwork, friendships, and disappointing her parents. She frequently has difficulty concentrating, trouble sleeping, and stomach aches before exams.

PATIENT RECORD SUMMARY

Patient Details

Name: Emily Dawson
Age: 15 years
Gender: Female
Gender Assigned at Birth: Female
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

Nil known

Medications

Nil currently

Past History

No previous medical or psychiatric diagnoses

Social History

Lives with both parents and one younger brother
No alcohol, smoking, or drug use

Family History

Mother has a history of generalised anxiety disorder
No known psychiatric hospitalisations in the family

Immunisations

Up to date

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

“I just feel like there’s too much going on, and I can’t handle it.”

General Information

Emily Dawson is a 15-year-old girl who has been struggling with persistent anxiety over the past few months. She is a high-achieving student who feels overwhelmed by academic pressure and social expectations. She wants to do well but constantly worries that she is not good enough.

She experiences:

Persistent anxiety about schoolwork, friendships, and expectations.
Physical symptoms such as stomach aches, muscle tension, and headaches.
Difficulty sleeping, often staying up late worrying about the next day.
Irritability and withdrawal, avoiding friends and skipping netball practice.

Specific Information

(Only reveal when asked relevant questions)

Background Information

Emily does not want to disappoint her parents, but she feels like she is constantly failing. She finds it hard to express her feelings to them because she doesn’t want to seem “weak” or like she’s making excuses.

She has come to the GP reluctantly after her mother insisted on bringing her. Her mother is frustrated and concerned, believing that Emily is overthinking things and just needs to “relax more.”

Symptoms and Timeline

Past few months: Feeling anxious almost every day, but worsening in the past 2–3 months.
Recent changes: More frequent stomach aches before school, trouble concentrating, difficulty sleeping.
Physical symptoms: Constant muscle tension, headaches, stomach aches before exams, occasional nausea.
Emotional symptoms: Feels on edge all the time, finds it hard to relax, irritable with family, avoids socialising.
Sleep problems: Takes hours to fall asleep, mind races with “what if” thoughts, wakes up feeling exhausted.

Triggers for Anxiety

Schoolwork and grades – feels pressure to excel but worries about failure.
Parental expectations – Wants to make her parents proud, but feels constant pressure.
Friendships – Feels like she has to please everyone, worries people secretly don’t like her.
Social media – Often compares herself to others and feels like she’s not as successful, pretty, or fun.
Perfectionism – Thinks mistakes mean she’s not good enough.

Thought Patterns

“I always think something bad will happen.”
“If I don’t do well in school, I’ll disappoint my parents.”
“My friends probably think I’m annoying.”
“Even when I have free time, I can’t switch off.”

Impact on Daily Life

Social life: Avoids going out with friends, stopped netball practice because she felt “too anxious.”
Academic performance: Still doing well, but struggles to concentrate and is falling behind on assignments.
Family relationships: Argues more with parents, especially about school, feels misunderstood.

Self-Harm and Risk Assessment

Denies self-harm or suicidal thoughts.
Feels exhausted and overwhelmed but hasn’t thought about hurting herself.
Worries that she’s “not normal” and that this will never get better.

Emotional Cues (Role-player should respond with appropriate emotions)

Nervous and hesitant at first, but opens up when reassured.
Embarrassed about her anxiety, doesn’t want to feel “different.”
Frustrated by feeling stuck, doesn’t know how to manage her emotions.
Anxious about being judged, reluctant to admit how bad she feels.

Questions for the Candidate (Ask these naturally during the conversation)

“Is there something wrong with me?”
“Will this ever go away?”
“Do I need medication for this?”
“How do I make my parents understand?”
“Is it normal to feel like this?”
“What if I never feel better?”

Expectations

(What Emily Wants from the Consultation)

Emily is unsure what to expect but wants:

Reassurance that her feelings are valid and that she is not alone.
A clear explanation of what anxiety is and why it happens.
Practical coping strategies that she can use in daily life.
Support in communicating with her parents about her struggles.
Guidance on whether she needs therapy or medication.

Emily does not want to be told to “just relax” or that she is “overreacting.” She needs the GP to take her concerns seriously and provide a clear plan to help her manage her anxiety.

Potential Challenges for the Candidate

Emily may be reluctant to open up at first, requiring a gentle, supportive approach.
She may express guilt about her anxiety, believing she is “weak” for struggling.
She may hesitate to discuss social media pressures or perfectionism unless specifically asked.
Parental involvement may be a challenge – Emily may not want her parents to know everything.
She may feel hopeless, needing reassurance that anxiety is manageable and treatable.

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take a focused psychosocial history, using a developmentally appropriate and confidential approach.

The competent candidate should:

Establish rapport with Emily, ensuring a safe, non-judgemental environment.
Use open-ended questions to explore school, friendships, family relationships, and social media use.
Identify key anxiety symptoms, including physical, emotional, and cognitive features.
Explore triggers for anxiety, including academic pressures, social concerns, and perfectionistic tendencies.
Assess impact on daily life, including school performance, sleep, appetite, and social withdrawal.
Conduct a HEADSS assessment (Home, Education, Activities, Drugs, Sexuality, Suicide/Safety).
Clarify self-harm and suicide risk while providing reassurance and support.
Maintain confidentiality while ensuring appropriate parental involvement.

Task 2: Assess the severity of anxiety symptoms and determine if further intervention is needed.

The competent candidate should:

Evaluate severity and functional impairment using the GAD-7 scale or similar screening tool.
Differentiate between normal stress, generalised anxiety disorder (GAD), social anxiety, and adjustment disorder.
Recognise physical manifestations of anxiety (e.g., stomach aches, muscle tension, fatigue).
Identify worsening trends, including avoidance behaviours, school refusal, and deteriorating mood.
Determine whether immediate intervention is required, considering:
- Suicidal ideation/self-harm risk (urgent escalation if present).
- Impact on daily function (e.g., school performance, friendships).
- Parental expectations and support system.
Discuss the benefits of early intervention, addressing Emily’s fears about seeking help.

Task 3: Explain your diagnosis and management plan to the patient, ensuring she understands her options.

The competent candidate should:

Explain what anxiety is in an age-appropriate, reassuring way.
Clarify that anxiety is common and treatable and that she is not alone.
Provide an individualised management plan, including:
- Cognitive Behavioural Therapy (CBT) as the first-line treatment.
- Relaxation techniques (e.g., breathing exercises, mindfulness).
- Addressing perfectionistic thinking patterns.
- Encouraging gradual exposure to anxiety-provoking situations.
Discuss when medication (e.g., SSRIs) may be considered, ensuring realistic expectations.
Address Emily’s concerns about stigma, confidentiality, and parental involvement.

Task 4: Provide education and support, including lifestyle modifications, school strategies, and referral options.

The competent candidate should:

Offer psychoeducation on anxiety, coping strategies, and self-care.
Advise on sleep hygiene, regular exercise, and limiting screen time before bed.
Discuss healthy social media use, including managing online comparisons.
Provide school-based strategies, such as liaising with a school counsellor or modifying workload.
Discuss family communication techniques, supporting Emily in expressing her feelings to her parents.
Arrange a Mental Health Care Plan for referral to a psychologist.
Schedule regular follow-ups to monitor progress and reassess risk factors.

SUMMARY OF A COMPETENT ANSWER

Builds rapport and conducts a confidential, developmentally appropriate psychosocial assessment.
Identifies anxiety symptoms, their severity, and functional impact.
Rules out urgent concerns, including self-harm and suicidal ideation.
Provides a clear diagnosis and explains evidence-based treatment options.
Offers practical strategies, including CBT, lifestyle modifications, and school interventions.
Involves parents appropriately while respecting Emily’s confidentiality.
Provides follow-up planning to ensure ongoing support.

PITFALLS

Failing to explore key triggers (e.g., school stress, parental expectations, social media).
Overlooking physical symptoms of anxiety (e.g., stomach aches, muscle tension).
Not screening for self-harm or suicidal ideation, missing an opportunity for escalation.
Minimising the impact of anxiety, suggesting she should “just relax.”
Failing to engage Emily in shared decision-making, focusing only on parental concerns.
Over-relying on medication without considering psychological interventions first.
Not scheduling appropriate follow-up, missing an opportunity for ongoing support.

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.
1.4 Engages the adolescent in a confidential and supportive manner.

2. Clinical Information Gathering and Interpretation

2.1 Takes a thorough history, including psychosocial and school-related stressors.
2.3 Identifies signs and symptoms of anxiety and comorbid mental health conditions.

3. Diagnosis, Decision-Making and Reasoning

3.1 Differentiates between normal stress, generalised anxiety disorder, and other mental health conditions.

4. Clinical Management and Therapeutic Reasoning

4.3 Develops an individualised management plan, including psychological interventions and lifestyle modifications.

5. Preventive and Population Health

5.2 Identifies risk factors for adolescent mental health conditions, including school stress, family conflict, and social media use.

6. Professionalism

6.2 Ensures confidentiality while managing parental expectations appropriately.

7. General Practice Systems and Regulatory Requirements

7.4 Provides appropriate referrals (e.g., mental health care plan, school counsellor).

9. Managing Uncertainty

9.2 Ensures appropriate follow-up and monitoring of anxiety symptoms.

10. Identifying and Managing the Patient with Significant Illness

10.1 Identifies signs of severe anxiety or potential self-harm risk and escalates care accordingly.

Competency at Fellowship Level

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