CASE INFORMATION

Case ID: CCE-2024-001
Case Name: James Turner
Age: 27
Gender: Male
Indigenous Status: Non-Indigenous
Year: 2024
ICPC-2 Codes: S18 – Abrasion/Scratch/Blister

COMPETENCY OUTCOMES

Competency Domain	Competency Element
1. Communication and Consultation Skills	1.1 Communicates appropriately to the person and the sociocultural context. 1.2 Engages the patient to gather information about symptoms, concerns, and impact. 1.4 Communicates effectively in routine and urgent situations.
2. Clinical Information Gathering and Interpretation	2.1 Gathers relevant clinical history and information. 2.2 Interprets findings to assess the severity of the injury.
3. Diagnosis, Decision-Making and Reasoning	3.1 Identifies and explains the nature of the injury. 3.3 Recognises complications such as infection.
4. Clinical Management and Therapeutic Reasoning	4.1 Develops an appropriate treatment plan. 4.2 Provides wound care advice and infection prevention.
5. Preventive and Population Health	5.1 Provides education on wound care and tetanus prevention.
6. Professionalism	6.2 Provides patient-centred care with appropriate reassurance.
7. General Practice Systems and Regulatory Requirements	7.1 Considers the need for documentation and potential workplace injury reporting.
8. Procedural Skills	8.1 Performs or advises on appropriate wound care procedures.
9. Managing Uncertainty	9.1 Recognises the need for follow-up and signs requiring escalation.
10. Identifying and Managing the Patient with Significant Illness	10.1 Identifies signs of wound infection or other complications.

CASE FEATURES

Neurovascular status – Any numbness, tingling, reduced movement?
Presentation: A 27-year-old male presents with a blistered and abraded forearm after a fall while playing soccer two days ago.
Key Concerns: The patient is worried about infection and whether he needs antibiotics.
Mechanism of injury – Fall on artificial turf, abrasion with dirt and debris present.
Current symptoms – Redness, pain, and minor clear discharge from the wound.
Tetanus vaccination status – Unsure when last tetanus booster was.
Comorbidities/Risk Factors – No known chronic conditions, but works as a chef (importance of hand hygiene).
Clinical Examination Considerations:
Wound assessment – Depth, signs of infection (heat, swelling, pus, fever).

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

James Turner, a 27-year-old chef, presents to the clinic with a blistered and abraded forearm sustained two days ago while playing soccer on artificial turf. He describes falling on his outstretched arm, scraping it against the rough surface.

Initially, he washed it with water, but didn’t use antiseptic. Now, he’s noticing redness and mild pain around the area, with some clear fluid oozing from the largest blister.

He’s concerned about infection and wonders if he needs antibiotics.

PATIENT RECORD SUMMARY

Patient Details

Name: James Turner
Age: 27
Gender: Male
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

No known drug allergies

Medications

Nil regular

Past History

No chronic conditions

Social History

Works as a chef

Family History

Nil significant

Smoking & Alcohol

Non-smoker
Social alcohol use

Vaccination & Preventative Care

Uncertain about last tetanus booster

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

“Hi Doc, I scraped my arm playing soccer a couple of days ago, and I think it might be getting infected. Do I need antibiotics?”

General Information

(Share freely when asked general questions like “Tell me what happened.”)

Two days ago, you were playing soccer on an artificial turf field when you tripped and fell forward.
Your forearm slid across the rough turf, causing a large scrape and some blisters.
You washed it with water when you got home but didn’t use antiseptic or cover it.
You didn’t think much of it at first, but now it looks red and is oozing a bit.
There is mild swelling and a bit of pain, but no fever or feeling unwell.

Specific Information

(Only reveal these details if asked direct questions.)

Symptoms & Progression

The blister on the biggest scraped area burst this morning, and there was clear fluid.
You noticed mild redness spreading around the wound today, and it feels warm to touch.
There’s no pus, but it looks a bit swollen compared to yesterday.
Pain level is about a 3/10, more of a stinging sensation when touched or when washing.

Work & Functional Impact

You work as a chef in a busy kitchen, handling food and washing your hands often.
You’re worried about the wound getting worse or becoming infected at work.
Your boss expects you to keep it covered, but you’re unsure if that’s the right approach.

Tetanus & Medical History

You’re not sure when your last tetanus shot was, possibly years ago.
You have no allergies, no chronic medical conditions, and you don’t take any regular medications.
You don’t smoke, and you drink alcohol socially on weekends.

Patient Concerns & Questions

(Ask these naturally during the consultation.)

“Does this look infected? I don’t want it to get worse.”
“Do I need antibiotics, or will it heal on its own?”
“When can I go back to work? Should I cover it while working?”
“Should I keep it dry, or should I clean it with something?”
“What signs should I look for if it does get infected?”

Emotional Cues & Behaviour

You’re mildly anxious because of the redness and swelling.
You’re not in severe pain, but you’re worried about complications.
You trust medical advice but want clear, practical instructions.
You feel relieved when given reassurance and specific steps to follow.
If the doctor doesn’t address your concerns clearly, you’ll ask again to be sure.

If the Doctor Recommends a Tetanus Shot

You’re a bit hesitant, asking, “Do I really need it?”
If explained well, you’ll agree to get the shot today.

If the Doctor Recommends Cleaning & Dressing the Wound

You’ll ask, “What should I use to clean it?”
You’ll want to know, “How often should I change the dressing?”
You’ll confirm, “When should I come back if it’s not getting better?”

If the Doctor Says You Don’t Need Antibiotics

You’ll ask, “How can I tell if I do end up needing them?”
If reassured, you’ll accept the advice but may ask, “So this should heal fine on its own?”

If the Doctor Gives Return-to-Work Advice

You’ll ask, “So, I should keep it covered at work? What kind of bandage?”
You’ll want to know, “Will washing my hands all the time slow down healing?”

End of Consultation

If you feel reassured, you’ll say:
“Okay, that makes sense. I’ll follow those instructions. Thanks, Doc!”

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take an appropriate history from the patient regarding their abrasion/scratch/blister

The competent candidate should:

Use open-ended questions to gather details about the mechanism of injury, including when and how it occurred.
Ask about wound care practices so far, including cleaning, dressing, and use of antiseptics or ointments.
Identify symptoms of infection, such as increasing pain, redness, warmth, swelling, pus, or systemic signs like fever.
Take a past medical history, including diabetes, immunosuppression, or peripheral vascular disease, which may impact healing.
Clarify tetanus vaccination status and offer a booster if indicated.
Inquire about functional impact, such as work, sports, or daily activities affected by the wound.

Task 2: Assess for possible infection and determine if antibiotics are required

The competent candidate should:

Evaluate for local signs of infection, including erythema, warmth, swelling, pain, and purulent discharge.
Assess for systemic symptoms such as fever, chills, or malaise.
Determine risk factors for poor wound healing, including diabetes, immunosuppression, malnutrition, or smoking.
Discuss indications for antibiotics, such as rapidly spreading cellulitis, purulent drainage, or systemic involvement.
Follow Therapeutic Guidelines Australia on when to use oral antibiotics vs. wound care alone.

Task 3: Provide appropriate wound care and preventive advice

The competent candidate should:

Recommend cleaning the wound with saline or mild antiseptic and advise against using irritating substances like hydrogen peroxide.
Advise on keeping the wound covered with a non-adherent dressing and changing it daily.
Educate on signs of worsening infection and when to seek medical review.
Explain workplace considerations, such as covering the wound at work (especially in food handling jobs).
Advise on tetanus prophylaxis if indicated.

SUMMARY OF A COMPETENT ANSWER

Detailed history of injury, wound care, symptoms of infection, and risk factors.
Thorough infection assessment including local and systemic signs.
Appropriate management based on wound condition—dressing, cleaning, antibiotics if needed.
Clear patient education on wound care, infection prevention, and follow-up.
Consideration of tetanus status and updating if required.

PITFALLS

Failing to assess for infection and risk factors for poor healing.
Overprescribing antibiotics when simple wound care is sufficient.
Not addressing patient concerns, such as return to work and activity limitations.
Ignoring tetanus immunisation status and missing an opportunity for prophylaxis.
Providing incorrect wound care advice, such as recommending alcohol or hydrogen peroxide for cleaning.

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.
1.4 Communicates effectively in routine and difficult situations.

2. Clinical Information Gathering and Interpretation

2.1 Takes a focused and relevant history.
2.2 Identifies red flags and risk factors for poor wound healing.

3. Diagnosis, Decision-Making, and Reasoning

3.1 Differentiates between a simple wound and an infected wound requiring intervention.
3.2 Uses evidence-based reasoning to determine if antibiotics are necessary.

4. Clinical Management and Therapeutic Reasoning

4.1 Provides appropriate first-aid and wound management.
4.2 Prescribes antibiotics only when clinically indicated.
4.3 Provides preventive health advice, including tetanus prophylaxis.

5. Preventive and Population Health

5.1 Recognises the role of tetanus vaccination in wound management.
5.2 Educates the patient on wound care and prevention of infection.

6. Professionalism

6.1 Provides clear, patient-centred advice with empathy.

7. General Practice Systems and Regulatory Requirements

7.1 Documents the wound assessment and management appropriately.

9. Managing Uncertainty

9.1 Recognises when a wound needs further review, such as worsening signs of infection.

Competency at Fellowship Level

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