CCE-CE-048 - GP Exams

CASE INFORMATION

Case ID: CCE-MS-008
Case Name: Daniel Foster
Age: 42
Gender: Male
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: L99 – Injury musculoskeletal NOS

COMPETENCY OUTCOMES

Competency Domain	Competency Element
1. Communication and Consultation Skills	1.1 Establishes rapport and engages the patient 1.2 Explores the patient’s concerns, ideas, and expectations 1.3 Provides clear and structured explanations about diagnosis, prognosis, and management
2. Clinical Information Gathering and Interpretation	2.1 Takes a focused history, including mechanism of injury, symptom progression, and functional limitations 2.2 Conducts appropriate musculoskeletal assessment and identifies red flags
3. Diagnosis, Decision-Making and Reasoning	3.1 Differentiates between soft tissue injury, fractures, and serious musculoskeletal conditions 3.2 Identifies when imaging or specialist referral is required
4. Clinical Management and Therapeutic Reasoning	4.1 Develops an appropriate pain management and rehabilitation plan 4.2 Provides evidence-based advice on recovery, activity modification, and physiotherapy
5. Preventive and Population Health	5.1 Provides education on injury prevention and workplace or activity modifications 5.2 Encourages lifestyle modifications to reduce future injury risk
6. Professionalism	6.1 Demonstrates empathy and patient-centred care
7. General Practice Systems and Regulatory Requirements	7.1 Identifies relevant workplace or insurance processes if the injury is work-related
8. Procedural Skills	8.1 Demonstrates knowledge of appropriate examination techniques and basic first-line management of musculoskeletal injuries
9. Managing Uncertainty	9.1 Recognises when an injury requires further investigation or specialist referral
10. Identifying and Managing the Patient with Significant Illness	10.1 Identifies and appropriately manages complications such as chronic pain or secondary issues from the injury

CASE FEATURES

Potential workplace or sports-related injury with medico-legal considerations
Recent musculoskeletal injury with functional limitations and pain
Uncertainty about severity and need for imaging or specialist referral
Concerns about pain management and recovery expectations

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

Daniel Foster, a 42-year-old warehouse manager, presents to your clinic with right shoulder pain following an incident at work three days ago. He was lifting a heavy box when he felt a sudden sharp pain in his shoulder. The pain has been persistent, with difficulty lifting his arm above shoulder height. He describes the pain as aching and sharp with movement, and mild at rest.

His main concerns are:

“Did I tear something? Do I need a scan?”
“How long will this take to heal? Can I still work?”
“Should I see a physio or do exercises at home?”

PATIENT RECORD SUMMARY

Patient Details

Name: Daniel Foster
Age: 42
Gender: Male
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

None known

Medications

Occasional ibuprofen for pain

Past History

No prior shoulder or musculoskeletal injuries
No known joint conditions

Social History

Works as a warehouse manager, physically active role

Family History

No family history of connective tissue disorders or inflammatory conditions

Smoking

Non-smoker

Alcohol

Drinks 1–2 beers on weekends

Vaccination and Preventative Activities

Up to date with 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.

SCRIPT FOR ROLE-PLAYER

Opening Line

“Doctor, I hurt my shoulder at work a few days ago, and it’s still really sore. Do you think I need a scan?”

General Information

Daniel Foster is a 42-year-old warehouse manager who presents with right shoulder pain following a work-related injury three days ago. He was lifting a heavy box when he felt a sudden sharp pain in his shoulder. Initially, he thought it was a minor strain, but the pain has not improved as much as he expected.

Specific Information

(To be revealed only when asked)

Background Information

He can still move his arm, but lifting it above shoulder height is difficult and painful. His pain is sharp during movement and dull at rest. He describes trouble sleeping, as lying on the affected side increases the pain.

Daniel is worried about how long this will take to heal. He has not taken time off work yet but finds tasks more difficult. His job involves lifting, reaching, and carrying. He is also concerned about whether he has a serious injury, such as a rotator cuff tear, and if he will need surgery.

His main concerns are:

“Did I tear something? Do I need a scan?”
“How long will this take to heal? Can I still work?”
“Should I see a physio or just rest?”

Pain and Functional Impact

Pain started suddenly during lifting.
Pain is worst when raising his arm above shoulder height or reaching behind his back.
At rest, the pain is dull, but any movement causes sharp discomfort.
Ibuprofen helps a little, but the pain still interferes with work and sleep.
Difficulty dressing, particularly putting on a jacket.
Can hold light objects but struggles with heavier lifting.

Work and Activity Concerns

Works in a physically demanding role—lifting, reaching, and carrying heavy objects.
Has not taken time off work but is modifying tasks to avoid aggravating pain.
Worried about long-term damage and whether he will be able to return to full duties.
Plays social tennis on weekends and is worried he won’t be able to return to sport.

Current Management

Taking ibuprofen twice daily—provides some relief but not complete.
Using a heat pack in the evenings, which helps relax the muscles.
Has not tried physiotherapy or exercises yet.

Emotional Cues

Daniel is practical and motivated to recover but concerned about work and long-term function.

Worried about severity: “Do you think I tore something?”
Concerned about work: “How long will I be out of action?”
Uncertain about treatment: “Should I see a physio or just rest?”
Wants clear advice: “Do I need a scan, or will it get better on its own?”

He is not overly anxious, but wants reassurance and a structured plan. If the doctor appears uncertain, he may push for imaging or specialist referral.

Questions for the Candidate

Daniel will ask some of these questions, particularly if the doctor does not address them directly:

“How do I know if I need a scan?”
“Could this be a rotator cuff tear?”
“What’s the best way to recover—rest or exercise?”
“Should I take time off work, or can I keep working?”
“Do I need to see a physio, or can I manage this on my own?”
“How long will it take before I feel normal again?”
“If this doesn’t get better, what are my options?”
“Do I need to report this injury for WorkCover?”

Expected Reactions Based on Candidate Performance

If the candidate provides clear, structured advice:

Daniel will be reassured and engaged in his recovery plan.
He will accept recommendations for physiotherapy and self-management strategies.
He may say, “That makes sense. I’ll start the exercises and see how it goes.”

If the candidate is vague or dismissive:

Daniel may seem frustrated or push for imaging unnecessarily.
He may express concern about long-term damage.
He might say, “But what if this is a tear? Shouldn’t I get it checked?”

If the candidate fails to address work concerns:

Daniel may say, “So, should I stop working completely, or can I modify tasks?”
If work-related issues are not discussed, he may ask, “Do I need to report this for WorkCover?”

Key Takeaways for the Candidate

Clearly explain when imaging is needed and when conservative management is appropriate.
Provide a structured recovery plan, including pain management, exercises, and workplace modifications.
Acknowledge the impact of the injury on work and daily activities.
Recommend physiotherapy or guided rehabilitation to ensure optimal recovery.
Discuss potential workplace compensation or return-to-work considerations if necessary.

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take an appropriate history, including mechanism of injury, symptom progression, and functional impact.

The competent candidate should:

Elicit a clear history of the injury, including mechanism, onset, immediate symptoms, and progression over time.
Assess current symptoms, including pain severity, nature (sharp, dull, radiating), and response to analgesia.
Determine functional limitations, including impact on work, daily activities, and sleep.
Screen for red flags, such as severe pain, instability, numbness, weakness, or prior joint injuries.
Clarify previous management, including use of pain relief, heat/ice, physiotherapy, or rest.

Task 2: Identify key factors requiring further assessment, including red flags for serious injury.

The competent candidate should:

Assess for structural damage, such as rotator cuff tears, fractures, or ligament injuries.
Recognise red flags, including:
- Persistent, severe pain unresponsive to analgesia.
- Significant weakness, numbness, or altered sensation.
- History of previous shoulder instability or dislocations.
- Signs of infection (fever, redness, warmth over the joint).
Determine the need for imaging, using clinical guidelines to decide on X-ray (fractures, dislocations) or ultrasound/MRI (soft tissue injuries, rotator cuff pathology).

Task 3: Provide an initial management plan, including pain relief, rehabilitation, and return to activity.

The competent candidate should:

Offer effective pain management, including paracetamol, NSAIDs, and localised measures (ice/heat, gentle movement).
Recommend appropriate rest and activity modification, avoiding heavy lifting but maintaining gentle mobility.
Provide rehabilitation guidance, including graded return to movement and early physiotherapy referral.
Set realistic expectations, explaining that soft tissue injuries may take weeks to heal, but early mobilisation improves outcomes.

Task 4: Discuss the need for imaging, specialist referral, or workplace considerations if relevant.

The competent candidate should:

Explain when imaging is warranted, emphasising that most soft tissue injuries do not require immediate scans unless red flags are present.
Discuss workplace modifications, such as temporary lifting restrictions, light duties, or time off work if necessary.
Address potential WorkCover or insurance claims, advising on appropriate documentation if required.
Refer for physiotherapy early, ensuring appropriate rehabilitation and preventing chronic pain or stiffness.
Arrange follow-up, ensuring monitoring of recovery and timely escalation if symptoms persist.

SUMMARY OF A COMPETENT ANSWER

Elicits a comprehensive history, covering mechanism of injury, symptoms, and functional impact.
Recognises red flags requiring further investigation, including neurological symptoms, severe pain, or joint instability.
Provides an evidence-based management plan, including pain relief, activity modification, and rehabilitation.
Explains when imaging is needed, avoiding unnecessary scans while ensuring appropriate investigations.
Considers workplace implications, addressing work modifications and potential compensation processes.
Ensures follow-up and escalation if symptoms persist, ensuring timely specialist referral if required.

PITFALLS

Failing to identify red flags, leading to missed diagnoses such as rotator cuff tears or fractures.
Over-reliance on imaging, leading to unnecessary investigations without clear clinical indications.
Providing vague or generic recovery advice, rather than a structured return-to-activity plan.
Not addressing work-related implications, leaving uncertainty about duties and return-to-work planning.
Delaying physiotherapy referral, increasing the risk of stiffness, prolonged pain, and delayed recovery.
Lack of follow-up planning, failing to monitor progress and adjust treatment if symptoms persist.

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, expectations of healthcare and the full impact of their illness experience on their lives.
1.3 Provides clear and structured explanations about diagnosis, prognosis, and management.

2. Clinical Information Gathering and Interpretation

2.1 Takes a focused history, including mechanism of injury, symptom progression, and functional limitations.
2.2 Conducts appropriate musculoskeletal assessment and identifies red flags.

3. Diagnosis, Decision-Making and Reasoning

3.1 Differentiates between soft tissue injury, fractures, and serious musculoskeletal conditions.
3.2 Identifies when imaging or specialist referral is required.

4. Clinical Management and Therapeutic Reasoning

4.1 Develops an appropriate pain management and rehabilitation plan.
4.2 Provides evidence-based advice on recovery, activity modification, and physiotherapy.

5. Preventive and Population Health

5.1 Provides education on injury prevention and workplace or activity modifications.
5.2 Encourages lifestyle modifications to reduce future injury risk.

6. Professionalism

6.1 Demonstrates empathy and patient-centred care.

7. General Practice Systems and Regulatory Requirements

7.1 Identifies relevant workplace or insurance processes if the injury is work-related.

8. Procedural Skills

8.1 Demonstrates knowledge of appropriate examination techniques and basic first-line management of musculoskeletal injuries.

9. Managing Uncertainty

9.1 Recognises when an injury requires further investigation or specialist referral.

10. Identifying and Managing the Patient with Significant Illness

10.1 Identifies and appropriately manages complications such as chronic pain or secondary issues from the injury.

Competency at Fellowship Level

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