CASE INFORMATION
Case ID: CCE-RISK-001
Case Name: Michael Johnson
Age: 52
Gender: Male
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: A99 – Risk Factor 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 risk factors and preventive strategies |
| 2. Clinical Information Gathering and Interpretation | 2.1 Takes a structured history, including lifestyle, family history, and relevant risk factors 2.2 Identifies key modifiable and non-modifiable risk factors for chronic disease |
| 3. Diagnosis, Decision-Making and Reasoning | 3.1 Assesses cardiovascular and metabolic risk based on guidelines 3.2 Identifies when further investigations (e.g., lipid profile, fasting glucose, BP monitoring) are required |
| 4. Clinical Management and Therapeutic Reasoning | 4.1 Develops a personalised risk reduction plan, including lifestyle modifications and pharmacotherapy if indicated 4.2 Provides evidence-based counselling on diet, exercise, smoking cessation, and alcohol reduction |
| 5. Preventive and Population Health | 5.1 Conducts a cardiovascular risk assessment based on Australian guidelines 5.2 Encourages appropriate health screenings (e.g., blood pressure, diabetes, lipid profile, bowel cancer screening) |
| 6. Professionalism | 6.1 Demonstrates empathy and a patient-centred approach |
| 7. General Practice Systems and Regulatory Requirements | 7.1 Documents risk assessment findings and management plan appropriately |
| 9. Managing Uncertainty | 9.1 Recognises when to reassess risk and modify the management plan accordingly |
| 10. Identifying and Managing the Patient with Significant Illness | 10.1 Identifies patients at high risk for chronic disease and implements preventive interventions |
CASE FEATURES
- Concerned about his long-term health after a friend had a heart attack
- Middle-aged male with multiple cardiovascular risk factors
- Overweight, borderline hypertension, strong family history of heart disease
- Smoker and moderate alcohol intake
- No previous formal cardiovascular risk assessment
INSTRUCTIONS
You have 15 minutes to complete the tasks for this case.
You should treat this consultation as if it is face to face.
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 52-year-old truck driver, presents for a general check-up after a friend suffered a heart attack.
His medical and family history includes:
- Borderline hypertension (last BP 138/88 mmHg).
- Overweight (BMI 29).
PATIENT RECORD SUMMARY
Patient Details
Name: Michael Johnson
Age: 52
Gender: Male
Indigenous Status: Non-Indigenous
Allergies and Adverse Reactions
- No known drug allergies
Medications
- None regularly
Past History
- No prior cardiac events or strokes
- No known diabetes or high cholesterol
Social History
- Truck driver, sedentary lifestyle
- Smokes 15 cigarettes/day, drinks alcohol regularly
Family History
- Father had an MI at 54 years old
- No known diabetes in family
Vaccination and Preventative Activities
- Nil
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, my mate just had a heart attack, and it’s made me wonder—what’s my risk?”
General Information
Michael Johnson is a 52-year-old truck driver who has never had a formal health check-up. He is here because his friend recently had a heart attack, which has made him think about his own health for the first time in years.
- Generally feels fine, no major symptoms, but unsure about his risk factors.
- Smokes daily, drinks regularly, and has a poor diet.
- Has never had his cholesterol or blood sugar checked.
Specific Information
(To be revealed only when asked)
Background Information
- Knows he is overweight but hasn’t tried to lose weight.
- Worried about his family history—his dad had a heart attack at 54.
- Not sure if he needs medication or just lifestyle changes.
Symptoms and General Health
(Michael will describe the following if asked about how he feels.)
- No chest pain or palpitations.
- Occasional mild shortness of breath with exertion.
- Sometimes feels tired but attributes it to his job.
- No known history of diabetes, cholesterol issues, or high blood pressure.
Lifestyle and Risk Factors
(Michael will provide the following details when asked about his daily habits.)
- Smokes 15 cigarettes per day, has never seriously tried to quit.
- Drinks 3-4 beers most nights, more on weekends.
- Eats a lot of takeaway and processed foods, few vegetables.
- Rarely exercises due to long working hours as a truck driver.
- Thinks losing weight would be too difficult.
Family History
(Michael will mention this if the candidate asks about his relatives.)
- Father had a heart attack at 54.
- No known diabetes in the family.
- No strokes or other major conditions among close relatives.
Readiness to Change
(Michael will express some resistance but is open to discussion.)
- “I know I should quit smoking, but it helps me relax.”
- “I like my beer, but I don’t think I drink too much.”
- “I’ve never really worried about my health before, but this heart attack thing has got me thinking.”
- “I don’t have time to cook healthy meals.”
Emotional Cues
Michael is concerned but not alarmed.
- He is open to learning about his risk but does not fully understand it.
- He may downplay his smoking and drinking if not approached sensitively.
- He does not want to be forced into lifestyle changes but is willing to listen to advice.
- If the doctor is dismissive, he may become defensive and lose interest in making changes.
Questions for the Candidate
Michael may ask some or all of the following:
- “How do I know if I’m at risk?”
- “What tests do I need?”
- “Will I have to take tablets for this?”
- “Can I still drink alcohol?”
- “Is it too late to quit smoking?”
- “If I start eating better and exercising, how much will that help?”
- “Do I need to go on a diet?”
- “How often should I come back for check-ups?”
Expected Reactions Based on Candidate Performance
If the candidate provides a clear explanation and structured plan:
- Michael will feel reassured and willing to make some changes.
- He may say: “Alright, I guess I should start making some changes before it’s too late.”
If the candidate is vague or dismissive:
- Michael may downplay his risks and ignore medical advice.
- He may say: “So, it’s not a big deal, right? I’ll just keep doing what I’m doing.”
Key Takeaways for the Candidate
- Take a structured history, identifying modifiable and non-modifiable risk factors.
- Perform a cardiovascular risk assessment, including BP, cholesterol, and diabetes screening.
- Provide clear lifestyle advice, including smoking cessation, diet, and exercise.
- Discuss potential pharmacotherapy if risk is high.
THE COMPETENT CANDIDATE
The competent candidate should be able to:
Task 1: Take an appropriate history, including lifestyle habits, medical history, family history, and cardiovascular risk factors.
The competent candidate should:
- Obtain a detailed lifestyle history, including:
- Smoking habits (15 cigarettes/day for 30 years).
- Alcohol intake (3-4 beers per night).
- Dietary habits (high in processed foods, low in vegetables).
- Physical activity levels (minimal due to sedentary truck-driving job).
- Identify key medical history and risk factors, including:
- Borderline hypertension (previous BP 138/88 mmHg).
- Overweight (BMI 29).
- No previous diabetes or cholesterol testing.
- Explore family history, particularly:
- Father had an MI at 54 years old.
- Assess patient’s readiness for change, exploring barriers and motivations.
Task 2: Conduct a cardiovascular risk assessment and determine if further investigations are required.
The competent candidate should:
- Use an evidence-based risk calculator (e.g., Australian Absolute Cardiovascular Risk Calculator) to estimate his 5-year CVD risk.
- Request appropriate investigations based on risk assessment:
- Fasting lipid profile (to assess cholesterol and triglyceride levels).
- Fasting glucose or HbA1c (to screen for diabetes).
- Repeat BP measurement (to confirm hypertension).
- Discuss screening for other conditions if indicated:
- Bowel cancer screening (FOBT recommended for 50+ years).
- Liver function tests (given alcohol consumption).
Task 3: Provide a personalised risk reduction plan, including lifestyle modifications, screening tests, and potential pharmacotherapy.
The competent candidate should:
- Smoking cessation:
- Offer brief intervention and counselling.
- Discuss Nicotine Replacement Therapy (NRT) or varenicline if ready to quit.
- Alcohol reduction:
- Encourage limiting alcohol to ≤2 standard drinks per day (per NHMRC guidelines).
- Dietary changes:
- Encourage a Mediterranean-style diet (high in vegetables, healthy fats, and lean protein).
- Reduce processed foods and sugary drinks.
- Exercise recommendations:
- Encourage at least 150 minutes of moderate physical activity per week (walking, resistance training).
- Consider pharmacotherapy if high CVD risk:
- Statins if LDL cholesterol is elevated.
- Antihypertensives if BP remains high on repeat measurement.
- Follow-up plan:
- Review in 4-6 weeks to assess progress.
- Encourage long-term monitoring of cardiovascular health.
Task 4: Educate the patient on long-term health risks and preventive strategies to reduce future cardiovascular events.
The competent candidate should:
- Explain his cardiovascular risk in simple terms:
- “Your lifestyle and family history put you at an increased risk of a heart attack or stroke within the next 5-10 years.”
- Provide motivation for change:
- “Quitting smoking alone can cut your heart attack risk in half within a year.”
- Discuss the benefits of early intervention:
- “Making changes now means a much better chance of avoiding serious health issues later.”
- Safety-netting and follow-up:
- “If you experience chest pain, shortness of breath, or other concerning symptoms, seek urgent medical attention.”
SUMMARY OF A COMPETENT ANSWER
- Takes a structured history, identifying modifiable and non-modifiable risk factors.
- Performs a cardiovascular risk assessment, requesting lipid profile, diabetes screening, and repeat BP measurement.
- Provides clear lifestyle modification advice, including smoking cessation, diet, exercise, and alcohol reduction.
- Discusses potential pharmacotherapy, if risk is high.
- Educates the patient on cardiovascular risk, benefits of prevention, and long-term health strategies.
PITFALLS
- Failing to assess all relevant risk factors, such as smoking, alcohol intake, diet, and physical activity.
- Overlooking the need for screening tests, missing undiagnosed hypertension, diabetes, or hyperlipidaemia.
- Dismissing the impact of lifestyle changes, focusing solely on medication without encouraging risk reduction.
- Failing to provide clear and realistic goals, making lifestyle changes seem overwhelming.
- Not addressing the patient’s readiness for change, leading to resistance and disengagement.
REFERENCES
- RACGP Guidelines for Preventive Activities in General Practice (Red Book)
- Australian Absolute Cardiovascular Risk Calculator
- NHMRC Alcohol Guidelines
- Heart Foundation on Cardiovascular Risk Reduction
- GP Exams – Risk factor NOS
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 risk factors and preventive strategies.
2. Clinical Information Gathering and Interpretation
2.1 Takes a structured history, including lifestyle, family history, and relevant risk factors.
2.2 Identifies key modifiable and non-modifiable risk factors for chronic disease.
3. Diagnosis, Decision-Making and Reasoning
3.1 Assesses cardiovascular and metabolic risk based on guidelines.
3.2 Identifies when further investigations (e.g., lipid profile, fasting glucose, BP monitoring) are required.
4. Clinical Management and Therapeutic Reasoning
4.1 Develops a personalised risk reduction plan, including lifestyle modifications and pharmacotherapy if indicated.
4.2 Provides evidence-based counselling on diet, exercise, smoking cessation, and alcohol reduction.
5. Preventive and Population Health
5.1 Conducts a cardiovascular risk assessment based on Australian guidelines.
5.2 Encourages appropriate health screenings (e.g., blood pressure, diabetes, lipid profile, bowel cancer screening).
6. Professionalism
6.1 Demonstrates empathy and a patient-centred approach.
7. General Practice Systems and Regulatory Requirements
7.1 Documents risk assessment findings and management plan appropriately.
9. Managing Uncertainty
9.1 Recognises when to reassess risk and modify the management plan accordingly.
10. Identifying and Managing the Patient with Significant Illness
10.1 Identifies patients at high risk for chronic disease and implements preventive interventions.
Competency at Fellowship Level
☐ CLEARLY BELOW STANDARD
☐ BELOW EXPECTED STANDARD
☐ BORDERLINE
☐ AT EXPECTED STANDARD
☐ ABOVE STANDARD