CCE-CE-108

CASE INFORMATION

Case ID: CCE-2025-002
Case Name: Sarah Thompson
Age: 28
Gender: Female
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: N88 (Epilepsy/Seizure Disorder)

COMPETENCY OUTCOMES

Competency DomainCompetency Element
1. Communication and Consultation Skills1.1 Establishes rapport and engages empathetically
1.2 Explains clinical information effectively
1.5 Negotiates a shared management plan
2. Clinical Information Gathering and Interpretation2.1 Takes a comprehensive history to assess seizure activity
2.2 Identifies red flags for secondary causes of seizures
3. Diagnosis, Decision-Making, and Reasoning3.1 Differentiates between seizure types
3.3 Recognises the need for further investigations
4. Clinical Management and Therapeutic Reasoning4.2 Develops a safe and evidence-based management plan
4.4 Provides lifestyle and driving advice in line with Australian regulations
5. Preventive and Population Health5.3 Provides education on seizure safety, triggers, and medication adherence
6. Professionalism6.2 Maintains patient confidentiality and engages in shared decision-making
7. General Practice Systems and Regulatory Requirements7.1 Provides appropriate certification and notification regarding fitness to drive
9. Managing Uncertainty9.2 Recognises when specialist referral is required
10. Identifying and Managing the Patient with Significant Illness10.1 Identifies and responds appropriately to new-onset seizures

CASE FEATURES

  • Young woman presenting with a possible new-onset seizure.
  • History of “blank spells” and a witnessed tonic-clonic seizure.
  • Concerns about driving, work, and independence.
  • Need for urgent neurological assessment and driving restriction.
  • Seizure safety education and medication initiation discussion.

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. Address the patient’s concerns.
  4. Develop a safe and patient-centred management plan.

SCENARIO

Sarah Thompson, a 28-year-old primary school teacher, has been brought in by her friend after experiencing a possible seizure.

Her friend witnessed Sarah suddenly fall to the ground, stiffen, jerk her arms and legs for about 1 minute, and then become drowsy and confused for about 15 minutes afterward. Sarah does not remember the event and feels exhausted with a headache.

Her BP today is 122/80 mmHg, HR 78 bpm, and she appears well but anxious.

PATIENT RECORD SUMMARY

Patient Details

Name: Sarah Thompson
Age: 28
Gender: Female
Gender Assigned at Birth: Female
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

  • Nil known

Medications

  • Nil regular medications

Past History

  • Nil significant medical history
  • No previous seizures or neurological conditions

Family History

  • Uncle with epilepsy

Social History

  • Works as a primary school teacher.
  • Occasionally drinks alcohol, does not use recreational drugs.

Smoking & Alcohol

  • Non-smoker.
  • Alcohol: Occasional social drinking.

Vaccination & Preventative Activities

  • All childhood vaccinations 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.

ROLE-PLAYER SCRIPT

Opening Line

“Doctor, my friend said I collapsed, but I don’t remember anything. What happened to me?”

General Information

  • You were at home with your friend, Jess, having a casual conversation when you suddenly fell to the ground.
  • Jess later told you that you jerked for about a minute and then appeared dazed for another 10–15 minutes.
  • You have no memory of the event—the last thing you remember is talking to Jess.
  • You woke up feeling confused, exhausted, and with a mild headache.

Specific Information

(Reveal Only When Asked)

Background Information

  • Your tongue feels sore, and you think you may have bitten it.
  • Your muscles feel a bit sore, especially in your arms and legs.
  • You are frightened because this has never happened before, and you don’t know what it means.

Symptoms Leading Up to the Event

  • You had been feeling fine earlier that day.
  • No fever, nausea, or dizziness before the event.
  • You didn’t feel faint or have any warning signs before collapsing.
  • You have felt tired recently, but you attributed it to stress at work.

History of Similar Episodes

  • Over the past few months, you have noticed occasional “blank spells”, where you:
    • Lose track of conversations for a few seconds.
    • Stare into space and then suddenly realise you weren’t paying attention.
    • Sometimes drop objects without realising why.
  • You haven’t thought much of it before, but now you wonder if it’s connected.

Family History

  • Your uncle has epilepsy, but you’ve never been told that it could run in families.
  • No other relatives have had seizures.

Social History & Lifestyle

  • You are a primary school teacher and love your job.
  • You live alone in an apartment in Melbourne.
  • You drive every day to work and for errands.
  • You don’t smoke and rarely drink alcohol.
  • No use of recreational drugs.

Medication & Medical History

  • No regular medications.
  • No history of head injuries, stroke, or serious infections.
  • No significant past medical history.

Emotional Cues

Fear & Anxiety

  • You clutch your hands together and speak hesitantly, worried about what this means for your future.
  • You ask “Does this mean I have epilepsy? Will this happen again?”
  • You are scared about living alone and wonder if it’s still safe.

Frustration

  • You sigh and say, “I was fine yesterday! How can this just happen out of nowhere?”
  • If told you can’t drive, you react with concern and frustration: “But I need my car for work! How long do I have to stop driving?”

Uncertainty About Work & Independence

  • You frown and ask, “Can I still work as a teacher? Will I lose my job if this happens again?”
  • You worry about needing medication and ask, “Will I have to take medication for the rest of my life?”
  • If the doctor doesn’t mention lifestyle changes, you ask: “Can I still exercise? Can I be alone at home?”

Key Questions for the Candidate

(Ask these naturally throughout the consultation, especially if the doctor hasn’t already addressed them.)

  1. “Does this mean I have epilepsy?”
  2. “Will I have more seizures? How can I stop them from happening?”
  3. “Can I still drive? How long will I have to stop?”
  4. “Can I keep working as a teacher? Will I lose my job?”
  5. “Do I have to take medication forever?”
  6. “Are there things I should avoid doing now?”

Possible Patient Reactions Based on the Candidate’s Response

If the Doctor Explains the Condition Clearly and Reassures You

  • You nod and say, “Okay, that makes sense. I guess I’ll need to be careful.”
  • You may ask, “What’s the next step? Do I need any tests?”

If the Doctor is Hesitant About Diagnosis or Driving Restrictions

  • You frown and say, “But I feel fine now! Why should I stop driving?”
  • If the doctor doesn’t bring up driving restrictions, you might ask, “What about my licence? Can I keep driving?”

If the Doctor Fails to Address Your Concerns About Work & Living Alone

  • You look worried and say, “What about my job? Can I still teach kids?”
  • You may say, “What if I have another seizure at home alone?”

Role-Player’s Objective

  • Encourage the candidate to take a structured approach: history-taking, explaining risks, and offering a clear management plan.
  • Assess the candidate’s ability to communicate effectively, ensuring you feel heard and informed.
  • Observe if the candidate manages your emotional state appropriately—do they acknowledge your fear and frustration?
  • Determine if the candidate ensures your immediate safety—do they arrange for investigations and discuss appropriate driving/work restrictions?

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take an appropriate history from the patient regarding the recent event.

The competent candidate should:

  • Establish rapport and a safe space for discussion, acknowledging the patient’s fear and uncertainty.
  • Take a structured seizure history, including:
    • Pre-event symptoms: Any warning signs (auras, déjà vu, strange smells, nausea, dizziness)?
    • During the event: Witness account of movements, duration, loss of bladder control, tongue biting.
    • Post-event: Confusion, headache, muscle soreness, drowsiness (postictal phase).
  • Explore any prior similar episodes, including blank spells or myoclonic jerks.
  • Ask about seizure triggers, such as lack of sleep, stress, alcohol, or flashing lights.
  • Assess risk factors for secondary seizures, including head injuries, infections, neurological conditions, family history of epilepsy, and substance use.
  • Confirm medications and adherence, ruling out any potential provoking factors (e.g., missed doses, drug interactions, alcohol use).
  • Address social history, including driving, work, and independent living safety concerns.

Task 2: Explain the likely diagnosis and the need for further investigations.

The competent candidate should:

  • Explain that the event is concerning for a seizure, but further investigations are required before confirming epilepsy.
  • Outline potential causes, including:
    • Primary epilepsy (idiopathic generalised or focal seizures).
    • Secondary causes (head trauma, tumours, stroke, metabolic imbalances, infections).
  • Discuss essential investigations, including:
    • Electroencephalogram (EEG) to assess brain electrical activity.
    • Brain imaging (MRI preferred, or CT if urgent) to rule out structural abnormalities.
    • Blood tests (FBC, UEC, LFTs, glucose, electrolytes) to exclude metabolic causes.
  • Reassure the patient that the next step is referral to a neurologist for formal assessment.
  • Address the importance of keeping a seizure diary and avoiding triggers.

Task 3: Discuss your immediate and longer-term management plan.

The competent candidate should:

  • Emphasise patient safety first, ensuring Sarah understands she cannot drive until medically cleared (per Austroads guidelines, a 6–12 month seizure-free period is required).
  • Arrange urgent referral to a neurologist for further assessment.
  • Educate on seizure precautions, including:
    • Avoiding heights, swimming alone, and operating machinery.
    • Ensuring safe showering and sleeping arrangements (low bed, padded surroundings).
  • Discuss lifestyle modifications, such as adequate sleep, stress reduction, and limiting alcohol/caffeine intake.
  • If epilepsy is confirmed, discuss antiepileptic medication options based on seizure type.

Task 4: Address the patient’s concerns, including driving, work, and lifestyle modifications.

The competent candidate should:

  • Acknowledge Sarah’s concerns and reassure her that many people with epilepsy live normal lives with appropriate management.
  • Driving: Clearly explain the legal driving restrictions, which require a seizure-free period before re-assessment.
  • Work: Discuss her job as a teacher, explaining that she may need temporary workplace adjustments but can likely continue working.
  • Living alone: Recommend seizure safety measures, such as alert devices and informing trusted individuals.
  • Future prognosis: Reassure that epilepsy can often be well-controlled with medication and lifestyle changes.
  • Provide written resources and recommend support groups (e.g., Epilepsy Action Australia) for additional guidance.

SUMMARY OF A COMPETENT ANSWER

  • Takes a structured seizure history, including pre-ictal, ictal, and post-ictal phases.
  • Recognises the need for urgent investigations (EEG, MRI, blood tests) and neurology referral.
  • Explains the diagnosis clearly while maintaining patient-centred communication.
  • Addresses safety concerns, particularly driving, work, and living alone.
  • Provides reassurance while balancing uncertainty and long-term planning.
  • Demonstrates knowledge of Australian regulations regarding driving and epilepsy management.

PITFALLS

  • Failing to recognise seizure red flags, such as unwitnessed events or focal neurological signs requiring urgent imaging.
  • Not addressing driving restrictions, leaving the patient unaware of legal and safety concerns.
  • Over-reassuring without explaining uncertainty, missing the need for specialist referral and further assessment.
  • Neglecting to discuss safety precautions, such as swimming, bathing, and heavy machinery risks.
  • Not providing adequate follow-up, including neurology referral and seizure diary instructions.

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

Competency Areas Assessed

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 Communicates effectively in routine and difficult situations.

2. Clinical Information Gathering and Interpretation

2.1 Takes a comprehensive history to assess seizure activity.
2.2 Identifies red flags for secondary causes of seizures.

3. Diagnosis, Decision-Making and Reasoning

3.1 Differentiates between seizure types.
3.3 Recognises the need for further investigations.

4. Clinical Management and Therapeutic Reasoning

4.2 Develops a safe and evidence-based management plan.
4.4 Provides lifestyle and driving advice in line with Australian regulations.

5. Preventive and Population Health

5.3 Provides education on seizure safety, triggers, and medication adherence.

6. Professionalism

6.2 Maintains patient confidentiality and engages in shared decision-making.

7. General Practice Systems and Regulatory Requirements

7.1 Provides appropriate certification and notification regarding fitness to drive.

9. Managing Uncertainty

9.2 Recognises when specialist referral is required.

10. Identifying and Managing the Patient with Significant Illness

10.1 Identifies and responds appropriately to new-onset seizures.

Competency at Fellowship Level

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