EXAMINER ONLY INFORMATION

QUESTIONS

Q1. How would you assess Michael’s stress reaction and determine the severity of his condition?

• Prompt: What key aspects of history and examination are relevant?
• Prompt: How do you differentiate acute stress reaction from PTSD?

Q2. What immediate management strategies would you implement?

• Prompt: What psychological first aid measures are effective?
• Prompt: How would you support his coping mechanisms?

Q3. When would you consider referral for psychological or psychiatric support?

• Prompt: What are the indications for early intervention?
• Prompt: When is specialist mental health referral needed?

Q4. How would you address Michael’s concerns about returning to work?

• Prompt: What workplace adjustments may be beneficial?
• Prompt: When should work leave or modifications be recommended?

Q5. What long-term strategies can help prevent progression to PTSD?

• Prompt: What role does structured follow-up play?
• Prompt: How can social and professional support be utilised?

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Q1: How would you assess Michael’s stress reaction and determine the severity of his condition?

Michael presents with acute distress after witnessing a fatal accident involving a child. A structured assessment includes history, mental state examination, and risk assessment.

1. History

• Event details – nature of trauma, proximity to the event
• Symptoms – intrusive thoughts, nightmares, hypervigilance, avoidance behaviours
• Impact on function – work performance, relationships, daily activities
• Coping mechanisms – social support, avoidance, alcohol or drug use
• Past mental health history – previous trauma, depression, anxiety

2. Mental State Examination

• Appearance and behaviour – tense, restless, tearful
• Mood and affect – anxious, distressed, reactive to discussion of event
• Thought content – no suicidal ideation, no delusions
• Cognition – intact, but preoccupied with the event

3. Differentiating Acute Stress Reaction vs PTSD

• Acute Stress Reaction (ASR) – onset within hours to days, resolves in 4 weeks
• PTSD – symptoms persist beyond 1 month, may include flashbacks, avoidance, and emotional numbing

Michael’s acute symptoms suggest ASR, requiring early support and monitoring for PTSD.

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Q2: What immediate management strategies would you implement?

1. Psychological First Aid

• Validate emotions – reassure that distress is a normal response
• Encourage social support – family, friends, work colleagues
• Provide a structured debriefing approach – allow him to express emotions in a controlled manner

2. Symptom Management

• Sleep hygiene education – reduce screen time, relaxation techniques
• Avoid alcohol and excessive caffeine – can worsen hyperarousal
• Short-term use of melatonin or low-dose sedating antihistamines if sleep is significantly impaired (avoid benzodiazepines)

3. Follow-Up Plan

• Review in 1-2 weeks to assess symptom trajectory
• Watch for PTSD progression

Michael’s care focuses on early intervention and supportive strategies.

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Q3: When would you consider referral for psychological or psychiatric support?

1. Early Psychological Support Indications

• Persistent distress impacting function (e.g., difficulty returning to work)
• High-risk occupation (paramedic) – benefits from trauma-focused care

2. Urgent Psychiatric Referral Indications

• Suicidal ideation or self-harm risk
• Severe dissociation or loss of reality contact
• Uncontrolled distress despite initial interventions

Referral ensures access to trauma-informed care when required.

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Q4: How would you address Michael’s concerns about returning to work?

1. Workplace Considerations

• Phased return to duty – lighter duties initially
• Access to employer mental health support

2. Assess Readiness

• Encourage early but gradual exposure – avoiding complete avoidance
• Monitor for emotional readiness and PTSD symptoms

Michael’s return-to-work plan balances psychological recovery with functional restoration.

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Q5: What long-term strategies can help prevent progression to PTSD?

1. Ongoing Monitoring

• Regular GP follow-ups (4-6 weeks post-incident)
• Screen for PTSD symptoms at 1-month mark

2. Structured Coping Strategies

• Mindfulness, breathing exercises, structured debriefing with colleagues
• Referral to trauma-informed therapy (CBT or EMDR if PTSD develops)

3. Lifestyle and Well-Being

• Exercise and sleep optimisation
• Social connection to maintain emotional resilience

Preventive strategies support resilience and reduce PTSD risk.

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SUMMARY OF A COMPETENT ANSWER

• Takes a structured history and mental health assessment
• Recognises ASR and differentiates it from PTSD
• Implements psychological first aid and supportive interventions
• Identifies indications for psychological or psychiatric referral
• Provides a structured return-to-work plan and preventive strategies

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PITFALLS

• Failing to screen for suicidal ideation and high-risk symptoms
• Over-reassuring without structured follow-up
• Prematurely diagnosing PTSD when symptoms are acute
• Overprescribing medications (e.g., benzodiazepines) instead of non-pharmacological strategies
• Neglecting workplace support and return-to-work planning

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REFERENCES

• RACGP Guidelines for Mental Health Care in General Practice
• Australian Centre for Posttraumatic Mental Health (Phoenix Australia) on Acute Stress Reaction and PTSD Guidelines
• Beyond Blue on Coping with Trauma
• Lifeline Crisis Support

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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 Uses a compassionate, trauma-informed approach when discussing stress reactions.
1.3 Effectively explains symptoms, management, and coping strategies.

2. Clinical Information Gathering and Interpretation

2.1 Takes a structured history to assess the severity and impact of the stress reaction.
2.3 Identifies risk factors for prolonged psychological distress or PTSD.

3. Diagnosis, Decision-Making and Reasoning

3.1 Differentiates between acute stress reaction, PTSD, and other psychiatric conditions.
3.3 Recognises when referral for psychological or psychiatric support is necessary.

4. Clinical Management and Therapeutic Reasoning

4.1 Provides appropriate short-term psychological support strategies.
4.4 Develops an individualised management plan including follow-up and referral pathways.

5. Preventive and Population Health

5.1 Discusses coping strategies, social support, and stress reduction techniques.

6. Professionalism

6.2 Provides a patient-centred and empathetic approach to trauma-related distress.

7. General Practice Systems and Regulatory Requirements

7.1 Ensures appropriate documentation and follow-up for mental health conditions.

8. Procedural Skills

8.2 Conducts a mental state examination and risk assessment.

9. Managing Uncertainty

9.1 Recognises when to initiate watchful waiting vs immediate intervention.

10. Identifying and Managing the Patient with Significant Illness

10.2 Identifies patients at risk of developing PTSD or suicidal ideation.

Competency at Fellowship Level

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