CASE INFORMATION

Case ID: GEN-012
Case Name: Emily Dawson
Age: 28 years
Gender: Female
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: X90 – Genital candidiasis (female)

COMPETENCY OUTCOMES

Competency Domain	Competency Element
1. Communication and Consultation Skills	1.1 Engages the patient to understand concerns, ideas, and expectations 1.2 Provides clear explanations tailored to the patient’s level of health literacy 1.4 Uses effective consultation techniques, including active listening and empathy
2. Clinical Information Gathering and Interpretation	2.1 Takes a detailed history to assess vaginal symptoms, risk factors, and red flags 2.2 Selects appropriate investigations based on clinical presentation
3. Diagnosis, Decision-Making and Reasoning	3.1 Develops a differential diagnosis for vulvovaginal symptoms 3.2 Identifies red flags requiring urgent intervention
4. Clinical Management and Therapeutic Reasoning	4.1 Develops a structured and evidence-based management plan 4.2 Provides advice on pharmacological and non-pharmacological management
5. Preventive and Population Health	5.1 Discusses lifestyle modifications and strategies to reduce recurrence
6. Professionalism	6.1 Maintains patient confidentiality and demonstrates ethical practice
7. General Practice Systems and Regulatory Requirements	7.1 Documents accurately and ensures appropriate follow-up
9. Managing Uncertainty	9.1 Provides reassurance and safety-netting when the diagnosis is unclear
10. Identifying and Managing the Patient with Significant Illness	10.1 Recognises features suggestive of a more serious underlying condition requiring further assessment

CASE FEATURES

Young woman presenting with vulvovaginal itching, discharge, and discomfort.
Exploring risk factors, including recent antibiotic use, diabetes, hormonal changes, and hygiene practices.
Differentiating between common causes of vaginal symptoms, including bacterial vaginosis, sexually transmitted infections (STIs), and irritant/contact dermatitis.
Discussing treatment options, including antifungal therapy, lifestyle modifications, and recurrence prevention.
Addressing patient concerns, including sexual transmission, hygiene myths, and self-management strategies.

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

Emily Dawson, a 28-year-old childcare worker, presents with vaginal itching, irritation, and thick white discharge over the past five days. She describes the discharge as “like cottage cheese” and denies any strong odour. She has no history of recurrent infections but recently completed a course of antibiotics for a sinus infection.

PATIENT RECORD SUMMARY

Patient Details

Name: Emily Dawson
Age: 28
Gender: Female
Gender Assigned at Birth: Female
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

No known drug allergies

Medications

Recently completed a 10-day course of amoxicillin for sinusitis
On combined oral contraceptive pill (COCP)

Past History

No history of STIs, diabetes, or immunosuppression
No history of recurrent vaginal infections

Social History

Works as a childcare worker
Uses the oral contraceptive pill, no other contraception

Family History

No family history of diabetes or autoimmune diseases

Smoking

Non-smoker

Alcohol

Drinks socially, 1-2 times per week

Vaccination and Preventative Activities

HPV vaccine completed
Last cervical screening test (CST) was 18 months ago, results normal

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, I’ve had this really uncomfortable itching down there for a few days now, and there’s this thick white discharge. Could it be an STI?”

General Information

Your name is Emily Dawson, and you are 28 years old.
You work as a childcare worker, so you are generally busy and on your feet all day.
You are in a long-term monogamous relationship of two years and have had no new sexual partners.
You are generally healthy, with no major medical conditions.
You take the combined oral contraceptive pill (COCP) for contraception.
You recently had a sinus infection and completed a 10-day course of amoxicillin about a week ago.

Specific Information

(Reveal only when asked directly)

Background Information

You have had vaginal itching, irritation, and discharge for the past five days.
The itching is intense, mainly around the vulva and vaginal entrance.
The discharge is thick, white, and clumpy, resembling cottage cheese.
There is no strong odour.
You feel some redness and irritation around the vaginal opening, making it uncomfortable to wear tight clothing or sit for long periods.
There is no pain during urination or sex, but some discomfort when wiping after using the toilet.

Vaginal Symptoms

The itching gets worse at night and after wearing tight clothes.
The discharge sticks to the vaginal walls but does not have a fishy or foul smell.
You have noticed some mild swelling around the vaginal entrance.
You feel some burning after using scented soap in the shower.

Possible Triggers

You recently took antibiotics for sinusitis and noticed symptoms a few days after finishing them.
You often wear synthetic underwear and tight leggings.
You sometimes use scented soaps and body washes in the shower.

Sexual History

You are in a stable, monogamous relationship and have had no new partners.
You do not have a history of STIs, and your last cervical screening test (CST) was normal.
Your partner has no symptoms, and you have not had unprotected sex with anyone else.
You have never had symptoms like this before.

Concerns and Expectations

You are worried this might be an STI and whether you need to tell your partner.
You are concerned about whether this will keep coming back.
You want to know why this happened and if your antibiotics caused it.
You are wondering if your contraceptive pill is affecting your vaginal health.
You are unsure if you need a test or if this can be treated straight away.
You want to know how to prevent this from happening again.

Red Flag Symptoms (Reveal only when asked directly)

No abnormal vaginal bleeding.
No lower abdominal or pelvic pain.
No fever, chills, or flu-like symptoms.
No nausea or vomiting.

Emotional Cues & Body Language

You are concerned but not panicked, wanting reassurance and clear answers.
If the doctor suggests this is likely thrush, you will ask:
- “How do you know for sure? Do I need a test?”
If the doctor mentions antifungal treatment, you may ask:
- “Which treatment is best? Cream or tablets?”
If the doctor suggests lifestyle changes, you might ask:
- “What should I do differently to stop this from coming back?”
If the doctor explains things well, you will feel reassured and open to following their advice.

Questions for the Candidate

(Ask these naturally throughout the consultation.)

“Could this be an STI? Do I need to tell my partner?”
“Why did this happen? Could it be from the antibiotics?”
“How do I treat it, and will it come back?”
“Do I need a test, or can I just take medicine for it?”
“Is there anything I should avoid to stop this from happening again?”
“Does my contraception have anything to do with this?”
“What happens if I don’t treat it? Will it go away on its own?”
“Can I still have sex while I have this infection?”

Key Behaviours & Approach

You are looking for clear answers and a treatment plan.
If the doctor only prescribes medication without explaining why, you will ask how they know it’s not something else.
If the doctor suggests waiting before treating, you will ask:
- “If I start treatment now, will it go away faster?”
If the doctor explains things well, you will feel relieved and ready to follow the advice.

Additional Context for the Role-Player

You trust doctors but want a logical explanation of the diagnosis.
You prefer practical advice rather than vague suggestions.
You are not overly anxious, but you want to make sure this isn’t something serious.
You don’t want unnecessary tests, but you also don’t want to ignore an STI if that’s a possibility.

Role-Player Summary

This case assesses the candidate’s ability to:

Take a structured history, identifying risk factors for genital candidiasis.
Provide a broad differential diagnosis, considering bacterial vaginosis, STIs, and irritant/contact dermatitis.
Offer appropriate treatment options, balancing pharmacological and lifestyle approaches.
Provide reassurance and education, addressing misconceptions about STIs and hygiene.
Ensure safety-netting and follow-up, advising when to return if symptoms persist or recur.

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take an appropriate history from the patient, considering potential causes of vulvovaginal symptoms.

The competent candidate should:

Elicit a detailed symptom history, including onset, duration, progression, and severity of itching, discharge, and irritation.
Clarify discharge characteristics, assessing colour, consistency, and odour.
Assess associated symptoms, such as dyspareunia, dysuria, abnormal bleeding, or systemic symptoms.
Explore possible triggers, including recent antibiotic use, hormonal contraception, hygiene practices, and clothing choices.
Review sexual history, including partner status, STI risk factors, and condom use.
Assess personal and family history, including diabetes, recurrent infections, or immune conditions.
Address the patient’s concerns about STIs and recurrence, providing accurate information and reassurance.

Task 2: Formulate a differential diagnosis and explain it to the patient.

The competent candidate should:

Explain that genital candidiasis is the most likely cause, given the recent antibiotic use, classic discharge, and itching without odour.
Discuss other possible conditions, including:
- Bacterial vaginosis (BV) – if discharge were thin, grey, and malodorous.
- Trichomoniasis (STI) – if associated with frothy, yellow-green discharge and partner symptoms.
- Chlamydia/Gonorrhoea – if there were abnormal bleeding or recent unprotected sex with a new partner.
- Irritant/contact dermatitis – if linked to hygiene products or clothing choices.
Reassure the patient that this is not an STI, but explain why testing may be considered if symptoms persist or risk factors are present.

Task 3: Address the patient’s concerns, including transmission risk, recurrence, and treatment options.

The competent candidate should:

Reassure that genital candidiasis is not an STI, and there is no need to notify the partner unless symptoms persist.
Explain treatment options, including:
- Topical antifungal (clotrimazole) vs. oral antifungal (fluconazole).
- Considerations for pregnancy and recurrence.
Discuss recurrence prevention, including:
- Avoiding excessive moisture (e.g., synthetic underwear, tight clothing).
- Minimising irritants (e.g., scented soaps, douching).
- Considering probiotics for patients prone to recurrence.
Address concerns about contraception, explaining that hormonal changes can influence vaginal flora but are not the main cause.
Provide clear safety-netting, advising follow-up if symptoms persist or worsen.

Task 4: Develop an initial management plan, including pharmacological treatment, lifestyle modifications, and follow-up.

The competent candidate should:

Prescribe antifungal treatment, selecting oral fluconazole (single dose) or intravaginal clotrimazole based on patient preference.
Advise on symptom relief, including cool compresses and avoiding tight clothing.
Discuss self-care strategies, such as good genital hygiene without over-washing.
Offer STI screening if clinically indicated, based on history and risk factors.
Arrange follow-up in 1-2 weeks if symptoms persist or recur.
Provide safety-netting advice, including when to return for reassessment.

SUMMARY OF A COMPETENT ANSWER

Takes a structured history, covering symptoms, triggers, sexual health, and systemic risk factors.
Provides a clear differential diagnosis, explaining why genital candidiasis is the most likely cause.
Addresses patient concerns empathetically, particularly regarding STIs, recurrence, and partner involvement.
Develops an evidence-based treatment plan, balancing antifungal therapy with preventive advice.
Ensures appropriate follow-up, advising the patient when to return if symptoms persist or recur.

PITFALLS

Failing to differentiate from other causes, such as BV, STIs, or irritant/contact dermatitis.
Overlooking red flag symptoms, such as abnormal bleeding, pelvic pain, or systemic signs of infection.
Not explaining the role of antibiotics, missing an opportunity for preventive advice.
Neglecting to discuss recurrence prevention, leading to ongoing patient distress.
Providing unclear follow-up advice, leaving the patient unsure when to return for review.

REFERENCES

MARKING

Each competency area is assessed 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 patient’s concerns and sociocultural context.
1.2 Engages the patient to gather information about symptoms, concerns, and expectations.
1.4 Communicates effectively in routine and difficult situations.

2. Clinical Information Gathering and Interpretation

2.1 Elicits a comprehensive history, including risk factors and differential diagnoses.
2.2 Orders appropriate investigations only if needed, avoiding unnecessary testing.

3. Diagnosis, Decision-Making and Reasoning

3.1 Develops a structured differential diagnosis for vaginal symptoms.
3.2 Identifies red flags requiring further assessment.

4. Clinical Management and Therapeutic Reasoning

4.1 Develops a structured, evidence-based treatment plan, incorporating antifungal therapy and self-care.
4.2 Provides pharmacological and non-pharmacological treatment options, ensuring a patient-centred approach.

5. Preventive and Population Health

5.1 Discusses recurrence prevention strategies, including hygiene and lifestyle modifications.

6. Professionalism

6.1 Maintains confidentiality and ethical decision-making.

7. General Practice Systems and Regulatory Requirements

7.1 Ensures accurate documentation and appropriate follow-up.

9. Managing Uncertainty

9.1 Provides reassurance and safety-netting, ensuring the patient understands when to seek further medical care.

10. Identifying and Managing the Patient with Significant Illness

10.1 Recognises features suggestive of a more serious underlying condition requiring escalation.

Competency at Fellowship Level

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