CCE-CE-016 - GP Exams

Case ID: 001-2025
Case Name: Michael Johnson
Age: 51
Gender: Male
Indigenous Status: Aboriginal and Torres Strait Islander (ATSI)
Year: 2025
ICPC-2 Codes:

A91 – Abnormal test results
T90 – Diabetes, non-insulin-dependent
K87 – Hypertension with involvement of target organs
T78 – Obesity

COMPETENCY OUTCOMES

Competency Domain	Competency Element
1. Communication and Consultation Skills	1.1 Engages the patient to understand their ideas, concerns, and expectations. 1.2 Provides clear, empathetic explanations tailored to the patient’s health literacy. 1.4 Uses culturally appropriate communication strategies.
2. Clinical Information Gathering and Interpretation	2.1 Gathers relevant history, including family history of cardiovascular disease, lifestyle factors, and risk assessment. 2.2 Interprets abnormal test results in the context of the patient’s overall health.
3. Diagnosis, Decision-Making and Reasoning	3.1 Forms a problem list incorporating abnormal test results, risk factors, and potential comorbidities. 3.5 Considers a structured approach to cardiovascular and metabolic risk management.
4. Clinical Management and Therapeutic Reasoning	4.1 Develops an evidence-based management plan addressing cardiovascular risk, metabolic health, and lifestyle modifications. 4.3 Initiates pharmacological and non-pharmacological interventions as appropriate.
5. Preventive and Population Health	5.1 Discusses the importance of lifestyle changes, including diet, exercise, and regular monitoring. 5.2 Explains the role of preventive screenings, including diabetes monitoring and cardiovascular assessments.
6. Professionalism	6.1 Provides patient-centred care while maintaining professional boundaries.
7. General Practice Systems and Regulatory Requirements	7.1 Ensures appropriate follow-up and documentation of chronic disease management.
9. Managing Uncertainty	9.2 Addresses patient concerns about test results and potential diagnoses with clear, structured reasoning.
10. Identifying and Managing the Patient with Significant Illness	10.1 Recognises the risk of progressive metabolic syndrome and cardiovascular complications.
11. Aboriginal Health Context (AH)	AH1.1 Considers social and cultural determinants of health in the management of Aboriginal and Torres Strait Islander patients.

CASE FEATURES

51-year-old Aboriginal man presenting for a routine health check.
Risk of metabolic syndrome, type 2 diabetes, and cardiovascular disease.
Strong family history of early cardiovascular disease.
Abnormal test results: elevated lipids, impaired fasting glucose, elevated GGT and AST.
No recorded vaccinations.

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 an appropriate history.
Outline the differential diagnosis and key investigations required.
Address the patient’s concerns.
Develop a safe and patient-centred management plan.

SCENARIO

Michael Johnson, a 51-year-old Aboriginal man, has come to your city-based clinic for a routine health check. He does not smoke or drink alcohol. His family history includes a father who died of a heart attack at 55 and an uncle who had a stroke at 50. He has been feeling generally well but is concerned about his weight.

Recent blood tests show:

1. Urea, Electrolytes, and Creatinine (UEC)

Test	Result	Normal Range
Sodium (Na⁺)	138 mmol/L	135 – 145 mmol/L
Potassium (K⁺)	4.3 mmol/L	3.5 – 5.2 mmol/L
Chloride (Cl⁻)	102 mmol/L	98 – 107 mmol/L
Bicarbonate (HCO₃⁻)	24 mmol/L	22 – 28 mmol/L
Urea	6.2 mmol/L	2.5 – 7.8 mmol/L
Creatinine	88 µmol/L	60 – 110 µmol/L
eGFR	> 90 mL/min/1.73m²	> 90 mL/min/1.73m²

2. Liver Function Tests (LFTs)

Test	Result	Normal Range
Total Bilirubin	12 µmol/L	3 – 20 µmol/L
ALT (Alanine Aminotransferase)	35 U/L	5 – 40 U/L
AST (Aspartate Aminotransferase)	55 U/L	10 – 40 U/L
ALP (Alkaline Phosphatase)	85 U/L	30 – 120 U/L
GGT (Gamma-Glutamyl Transferase)	80 U/L	5 – 50 U/L
Albumin	42 g/L	35 – 50 g/L
Total Protein	72 g/L	60 – 80 g/L

3. Blood Sugar Levels (BSL)

Test	Result	Normal Range
Fasting BSL	6.3 mmol/L	3.9 – 5.5 mmol/L

4. Lipid Profile

Test	Result	Normal Range
Total Cholesterol	6.2 mmol/L	< 4.0 mmol/L
LDL Cholesterol	4.1 mmol/L	< 2.5 mmol/L
HDL Cholesterol	1.2 mmol/L	> 1.0 mmol/L
Triglycerides	2.5 mmol/L	< 1.7 mmol/L

He is unaware of what these results mean and is concerned about his risk of diabetes and heart disease. He wants to know what he can do to improve his health and whether he needs medication.

PATIENT RECORD SUMMARY

Patient Details

Name: Michael Johnson
Age: 51
Gender: Male
Gender Assigned at Birth: Male
Indigenous Status: Aboriginal

Allergies and Adverse Reactions

None known

Medications

None currently

Past History

Overweight for the past 10 years
No known chronic illnesses

Social History

Works as a warehouse supervisor
Walks occasionally but does not exercise regularly

Family History

Father: Died of myocardial infarction at 55
Uncle: Stroke at 50
Mother: Hypertension

Smoking

Never smoked

Alcohol

Does not drink alcohol

Vaccination and Preventative Activities

No recorded vaccinations

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

“Doctor, I came in for a health check, but they told me my blood test results weren’t good. What does that mean?”

General Information

You came in for a routine health check because you’ve been meaning to take better care of yourself.
You feel mostly fine but are a little worried about your weight.
You work full-time as a warehouse supervisor. Your job is mostly standing and walking around, but you wouldn’t call it exercise.
You don’t smoke or drink alcohol.

Specific Information

(Provide Only If Asked)

Background Information

You don’t have any major medical conditions that you know of.
You have never been on regular medications.
You don’t have regular GP check-ups but thought it was time to check in on your health, especially with your family history.
You’re unsure if you’ve ever had vaccinations—no recent flu shots, and you can’t recall having other vaccines as an adult.

Lifestyle and Diet

You live with your wife and two kids.
Meals are usually takeaway or something easy at home—lots of processed foods, white bread, fried foods, and soft drinks.
You don’t eat a lot of fruit or vegetables, mostly because you’re busy and don’t think about it.
You sometimes skip meals and end up eating big portions later in the day.
You don’t have a regular exercise routine. You walk a little bit for work but don’t do any structured physical activity.
You feel too tired after work to exercise and don’t know where to start.

Symptoms and Health Concerns

Lately, you’ve been feeling a bit more tired, especially in the afternoons.
After big meals, you sometimes feel sluggish and thirsty.
You don’t wake up to urinate at night, and you haven’t noticed any vision changes.
No history of chest pain or shortness of breath.
You’ve never been tested for diabetes before.
You don’t have any pain, but sometimes you feel bloated after eating.

Family History and Risk Perception

Your father died of a heart attack at 55.
Your uncle had a stroke at 50.
Your mother has high blood pressure.
You worry that you might have a heart attack like your dad.
You want to know if you have diabetes or if you’re heading that way.
You’re also a bit concerned about the liver test results.

Emotional Cues and Body Language

You look slightly anxious when the doctor starts explaining the test results.
When diabetes is mentioned, you lean in slightly, showing more concern.
You cross your arms when discussing medications, suggesting hesitation.
You nod when lifestyle changes are mentioned, showing you are open to learning more.
You sigh when discussing exercise and diet, indicating frustration or overwhelm.
When family history is discussed, you look down and pause, showing sadness or fear.

Questions for the Candidate (Ask Naturally During the Consultation)

“Does this mean I have diabetes?”
“Is this serious? Am I at risk of a heart attack like my dad?”
“What do I need to change? Is it too late for me to turn this around?”
“Do I need to take medication, or can I fix this with diet and exercise?”
“What do those liver results mean? Is my liver damaged?”
“How can I lose weight? I’ve tried before, but nothing sticks.”
“Do I need more tests? Should I be seeing a specialist?”

Concerns and Expectations

You want clear, simple explanations without too much medical jargon.
You’re worried about diabetes and heart disease because of your family history.
You are open to making lifestyle changes but feel unsure of where to start.
You prefer to avoid medications if possible but will consider them if necessary.
You’re not sure if you should be worried about your liver tests.
You would like practical advice on food and exercise that fits into your busy life.
You want to know if you need follow-up tests or regular check-ups from now on.

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take any further history required

The competent candidate should:

Elicit lifestyle factors, including diet, physical activity, and stress levels.
Explore symptoms suggestive of metabolic syndrome or diabetes, such as fatigue, polyuria, polydipsia, nocturia, weight changes, or blurred vision.
Assess cardiovascular risk factors, including family history of early cardiovascular disease (CVD), previous lipid profiles, blood pressure history, and any prior cardiovascular symptoms.
Clarify alcohol intake and substance use, even though the patient denies drinking, to confirm there are no contributing factors to the elevated liver function tests.
Explore psychosocial factors such as motivation for change, health literacy, access to healthcare, and barriers to lifestyle modifications.
Review vaccination history and discuss the need for age-appropriate immunisations, including influenza, pneumococcal, and COVID-19 vaccines.

Task 2: Explain the test results to the patient

The competent candidate should:

Use patient-friendly language, avoiding medical jargon while ensuring the patient understands the significance of the findings.
Explain each abnormal result clearly:
- Elevated lipids: Increased risk of heart disease and stroke.
- Impaired fasting glucose: Possible early diabetes (pre-diabetes), which requires lifestyle changes to prevent progression.
- Elevated GGT and AST: Could indicate early liver dysfunction, possibly due to metabolic factors rather than alcohol-related damage.
Provide context about cardiovascular and metabolic risks, linking the results to his strong family history of CVD.
Address patient concerns empathetically, ensuring the patient does not feel overwhelmed.
Check understanding by using teach-back techniques and asking the patient to summarise key points.

Task 3: Detail your management plan

The competent candidate should:

Develop a patient-centred, culturally appropriate plan, incorporating lifestyle modifications as the primary intervention.
Discuss dietary changes, recommending a Mediterranean or plant-based diet while minimising processed foods and sugary drinks.
Encourage physical activity, advising a gradual increase in exercise (e.g., walking 30 minutes daily).
Discuss weight management, setting realistic goals and considering referral to a dietitian.
Address metabolic risk factors, scheduling repeat fasting glucose and lipid testing in 3 months.
Consider pharmacotherapy if needed, such as statins or metformin, if lifestyle changes do not adequately control risk factors.
Monitor liver function tests and consider ultrasound if abnormalities persist.
Recommend vaccinations, particularly for influenza, pneumococcal, and COVID-19.
Arrange follow-up in 3 months, ensuring accountability and ongoing support.

SUMMARY OF A COMPETENT ANSWER

Elicits key lifestyle and risk factors, including diet, physical activity, and family history.
Explains abnormal test results clearly, using simple language and ensuring patient understanding.
Links findings to cardiovascular and metabolic risk, addressing concerns about diabetes and heart disease.
Provides a structured, culturally sensitive management plan, prioritising lifestyle modifications.
Considers preventive care, including vaccinations and follow-up strategies.
Engages the patient in shared decision-making, empowering them to take ownership of their health.

PITFALLS

Failing to explore psychosocial and cultural barriers, which may impact the patient’s ability to make lifestyle changes.
Using overly technical language, leading to confusion or disengagement.
Focusing solely on individual test results without explaining their overall significance in cardiovascular and metabolic health.
Overemphasising pharmacological treatment without discussing lifestyle interventions first, unless clinically indicated.
Not checking patient understanding or failing to address their concerns about medications and long-term health risks.
Ignoring the opportunity for preventive care, such as vaccinations and structured follow-up.

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 of healthcare.
1.4 Communicates effectively in routine and difficult situations.

2. Clinical Information Gathering and Interpretation

2.1 Gathers relevant history, including lifestyle, family history, and cardiovascular/metabolic risk factors.
2.2 Interprets abnormal test results in the context of overall health risk.

3. Diagnosis, Decision-Making and Reasoning

3.1 Forms a problem list incorporating abnormal test results, risk factors, and potential comorbidities.
3.5 Considers a structured approach to cardiovascular and metabolic risk management.

4. Clinical Management and Therapeutic Reasoning

4.1 Develops an evidence-based management plan addressing cardiovascular risk, metabolic health, and lifestyle modifications.
4.3 Initiates pharmacological and non-pharmacological interventions as appropriate.

5. Preventive and Population Health

5.1 Discusses the importance of lifestyle changes, including diet, exercise, and regular monitoring.
5.2 Explains the role of preventive screenings, including diabetes monitoring and cardiovascular assessments.

6. Professionalism

6.1 Provides patient-centred care while maintaining professional boundaries.

7. General Practice Systems and Regulatory Requirements

7.1 Ensures appropriate follow-up and documentation of chronic disease management.

9. Managing Uncertainty

9.2 Addresses patient concerns about test results and potential diagnoses with clear, structured reasoning.

10. Identifying and Managing the Patient with Significant Illness

10.1 Recognises the risk of progressive metabolic syndrome and cardiovascular complications.

11. Aboriginal Health Context (AH)

AH1.1 Considers social and cultural determinants of health in the management of Aboriginal and Torres Strait Islander patients.

Competency at Fellowship Level

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