EXAMINER ONLY INFORMATION

QUESTIONS

Q1. How would you assess Lisa’s current health status and risk factors?

• Prompt: What history and examination findings are relevant?
• Prompt: What tools or screening assessments could be used?

Q2. What dietary and lifestyle modifications would you recommend for Lisa?

• Prompt: What are the key principles of sustainable healthy eating?
• Prompt: How can she incorporate physical activity into her routine?

Q3. How would you address Lisa’s concerns about diet misinformation and previous struggles with weight management?

• Prompt: How can you use motivational interviewing to support behaviour change?
• Prompt: How do you help her navigate evidence-based dietary recommendations?

Q4. What preventive health strategies should be considered for Lisa at her age?

• Prompt: What screening tests are relevant for a healthy young woman?
• Prompt: What lifestyle interventions can help prevent chronic disease?

Q5. When would you consider referring Lisa to other healthcare professionals?

• Prompt: What are indications for dietitian or exercise physiologist referral?
• Prompt: When should specialist input (e.g., endocrinology, mental health) be considered?

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Q1: How would you assess Lisa’s current health status and risk factors?

Lisa is a 30-year-old woman with recent weight gain and concerns about long-term health risks. A structured assessment includes history, examination, and relevant screening tests.

1. History

• Dietary habits – meal frequency, portion sizes, processed food intake, snacking
• Physical activity – current exercise routine, barriers to activity
• Sleep patterns – quality, duration, fatigue levels
• Mental health – stress, emotional eating, past dieting experiences
• Family history – diabetes, cardiovascular disease, obesity-related conditions
• Lifestyle factors – alcohol intake, smoking, work schedule

2. Physical Examination

• BMI (26 kg/m²) and waist circumference (85 cm)
• Blood pressure and cardiovascular assessment
• Screen for signs of nutritional deficiencies (e.g., skin, hair, nails, mucosa)

3. Screening Tools

• AUSDRISK score (Type 2 diabetes risk assessment)
• Mental health screening if concerns arise

Lisa is in the overweight category with no current metabolic abnormalities, but her lifestyle poses risks for future chronic disease.

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Q2: What dietary and lifestyle modifications would you recommend for Lisa?

1. Dietary Modifications

• Encourage a whole-food, nutrient-dense diet
• Reduce processed foods and refined sugars
• Increase fibre intake (vegetables, whole grains, legumes)
• Meal planning and mindful eating to improve portion control
• Hydration – reduce sugary drinks, increase water intake

2. Physical Activity

• Gradual increase in daily movement (e.g., walking meetings, stairs)
• Structured exercise plan (150+ minutes/week of moderate-intensity activity)
• Incorporate resistance training twice per week

3. Behavioural Strategies

• Set SMART goals (specific, measurable, achievable, relevant, time-bound)
• Address emotional eating and stress management

4. Follow-up Plan

• Regular reviews to track progress and adjust strategies

Lisa benefits from small, achievable changes that fit her lifestyle.

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Q3: How would you address Lisa’s concerns about diet misinformation and previous struggles with weight management?

1. Validate and Acknowledge Challenges

• Recognise frustration with conflicting information
• Reinforce that weight management is complex and long-term

2. Motivational Interviewing Techniques

• Explore past successes and challenges – “What has worked well for you before?”
• Encourage self-efficacy – “What small step could you take this week?”

3. Navigating Nutrition Information

• Encourage evidence-based sources (NHMRC, Heart Foundation)
• Clarify myths about fad diets, rapid weight loss, and “detox” products

4. Practical Solutions for Sustainable Change

• Focus on progress, not perfection
• Emphasise consistency over extreme restrictions

Lisa needs realistic, sustainable strategies rather than restrictive diets.

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Q4: What preventive health strategies should be considered for Lisa at her age?

1. Metabolic Screening (If Indicated)

• Fasting glucose and HbA1c (if AUSDRISK score suggests increased risk)
• Lipid profile (if additional cardiovascular risk factors present)

2. Cancer Screening

• Cervical screening test (every 5 years for women aged 25-74)
• Encourage regular skin checks if high sun exposure

3. Lifestyle Counselling

• Tobacco and alcohol advice
• Optimise sleep hygiene

Lisa has no immediate medical concerns, but preventive strategies reduce long-term risks.

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Q5: When would you consider referring Lisa to other healthcare professionals?

1. Dietitian Referral

• Personalised meal planning
• Guidance on managing cravings and portion control

2. Exercise Physiologist

• Structured activity plan tailored to fitness level and preferences

3. Psychologist

• If emotional eating or body image concerns affect wellbeing

4. Specialist Referral

• Endocrinologist if unexplained weight changes or metabolic concerns arise

A multidisciplinary approach supports sustainable health improvements.

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SUMMARY OF A COMPETENT ANSWER

• Thoroughly assesses diet, activity, and lifestyle risk factors
• Provides evidence-based dietary and exercise recommendations
• Uses motivational interviewing to address misinformation and barriers
• Implements preventive health strategies appropriate for Lisa’s age
• Refers to allied health professionals where needed

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PITFALLS

• Failing to assess psychosocial and lifestyle factors impacting weight
• Providing generic advice without personalising recommendations
• Overlooking screening for long-term metabolic risks
• Not addressing misinformation or previous struggles with weight management
• Ignoring the role of allied health in supporting behaviour change

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REFERENCES

• RACGP Red Book on Guidelines for Preventive Activities in General Practice
• NHMRC Australian Dietary Guidelines
• Therapeutic Guidelines on Nutrition and Metabolic Health
• Diabetes Australia on Type 2 Diabetes Prevention

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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 Effectively engages with the patient to discuss health education and lifestyle changes.
1.3 Uses motivational interviewing techniques to assess readiness for change.

2. Clinical Information Gathering and Interpretation

2.1 Takes a thorough history, including dietary, lifestyle, and psychosocial factors.
2.3 Identifies risk factors for chronic diseases and preventive opportunities.

3. Diagnosis, Decision-Making and Reasoning

3.1 Assesses nutritional status and lifestyle impact on health.
3.3 Identifies when further investigations or specialist input are required.

4. Clinical Management and Therapeutic Reasoning

4.1 Provides tailored health education and preventive strategies.
4.4 Develops an individualised action plan to support sustainable behaviour change.

5. Preventive and Population Health

5.1 Implements evidence-based dietary and lifestyle recommendations to reduce chronic disease risk.

6. Professionalism

6.2 Provides non-judgmental, patient-centred care that supports health literacy.

7. General Practice Systems and Regulatory Requirements

7.1 Uses preventive health screening and lifestyle modification plans appropriately.

8. Procedural Skills

8.2 Interprets relevant clinical and nutritional assessments.

9. Managing Uncertainty

9.1 Addresses patient concerns and barriers to implementing health advice.

10. Identifying and Managing the Patient with Significant Illness

10.2 Recognises when lifestyle interventions are insufficient and medical intervention is required.

Competency at Fellowship Level

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