Case Information
- Case ID: GC-003
- Patient Name: Mark Thompson
- Age: 52
- Gender: Male
- Indigenous Status: Non-Indigenous
- Year: 2025
- ICPC-2 Codes: A30 – General Health Maintenance/Check-Up
Competency Outcomes
| Competency Domain | Competency Element |
|---|---|
| 1. Communication and Consultation Skills | Establishing rapport and discussing preventive health measures tailored to the patient’s context |
| 2. Clinical Information Gathering and Interpretation | Conducting a structured history, including cardiovascular risk assessment and lifestyle factors |
| 3. Diagnosis, Decision-Making and Reasoning | Identifying key health risks based on history, examination, and investigations |
| 4. Clinical Management and Therapeutic Reasoning | Developing a preventive health plan, including lifestyle advice and screening recommendations |
| 5. Preventive and Population Health | Implementing age-appropriate screening and vaccinations |
| 6. Professionalism | Maintaining a patient-centred approach and ethical communication |
| 7. General Practice Systems and Regulatory Requirements | Ordering Medicare-eligible health assessments and referrals where necessary |
| 9. Managing Uncertainty | Addressing incidental findings appropriately |
| 10. Identifying and Managing the Patient with Significant Illness | Recognising red flags requiring further investigation or specialist referral |
Case Features
- No history of diabetes, but interested in discussing his risk factors for chronic disease.
- 52-year-old male presenting for a routine check-up at the request of his wife.
- No specific complaints, but interested in checking his heart health and cholesterol.
- Works full-time as a construction manager, often eats takeaway due to work schedule.
- Family history of cardiovascular disease (father had an MI at 54, mother with hypertension).
- Borderline hypertension noted in a previous consultation but never followed up.
- Sedentary lifestyle, BMI 29 kg/m², and occasional alcohol binge drinking.
- Current smoker (15 cigarettes/day), no previous quit attempts.
- Not up to date with colorectal cancer screening (never had a FOBT or colonoscopy).
Instructions
The candidate is expected to review the following patient record and scenario. The examiner will ask a series of questions based on this information. The candidate has 15 minutes to complete this case.
The approximate time allocation for each question:
- Question 1: 3 minutes
- Question 2: 3 minutes
- Question 3: 3 minutes
- Question 4: 3 minutes
- Question 5: 3 minutes
Patient Record Summary
Patient Details
- Name: Mark Thompson
- Age: 52
- Gender: Male
- Indigenous Status: Non-Indigenous
Allergies and Adverse Reactions
- Nil known
Medications
- No regular medications
Past History
- Borderline hypertension (not treated, last BP reading 138/88 mmHg)
- No previous history of cardiovascular events or diabetes
Social History
- Works as a construction manager (long hours, high stress)
- Married with two adult children
- Smoking: 15 cigarettes/day for 30 years
- Alcohol: binge drinking on weekends (4-6 standard drinks at a time)
- Diet: High in processed foods, low in fresh vegetables
- Exercise: No regular physical activity
Family History
- Father had an MI at 54
- Mother with hypertension
- No known family history of diabetes or cancer
Vaccination and Preventative Activities
- Influenza vaccine: Not up to date
- COVID-19 booster: Declined
- Colorectal cancer screening: Never done
- PSA screening: Never done
- Lipid profile: Not checked in the past 5 years
Scenario
Mark Thompson, a 52-year-old construction manager, presents for a general check-up at the request of his wife. He does not have any specific complaints but wants to check his heart health and cholesterol. He has never had a colorectal cancer screen and is unaware of the recommended health checks for men his age.
He has been a smoker for 30 years and has never attempted to quit. He acknowledges his diet is poor, with frequent takeaway meals and minimal exercise. He drinks socially on weekends, sometimes exceeding safe drinking limits.
He has borderline hypertension, which was noted previously but never formally diagnosed or treated. His father had a heart attack at 54, and he is concerned about his own risk of heart disease.
On examination:
- Blood Pressure: 140/90 mmHg
- Heart Rate: 78 bpm
- BMI: 29 kg/m² (overweight)
- Waist circumference: 102 cm (central obesity)
- Lungs: Clear, but mild tobacco staining on fingers
- Cardiovascular: No murmurs, pulses normal
- Abdomen: No hepatosplenomegaly, no masses
Investigations Ordered:
- PSA test (shared decision-making required)
- Lipid profile
- Fasting glucose and HbA1c
- eGFR and urine ACR (diabetes screening)
- Faecal occult blood test (FOBT)
Examiner Only Information
Questions
Q1. What are the key health risks and screening priorities for this patient?
- Prompt: What cardiovascular risk factors need to be addressed?
- Prompt: What age-appropriate screenings should be offered?
Q2. How would you assess Mark’s cardiovascular risk and what lifestyle advice would you provide?
- Prompt: How would you calculate his cardiovascular risk?
- Prompt: What specific lifestyle modifications would you recommend?
Q3. How would you approach smoking cessation for Mark?
- Prompt: What evidence-based strategies are available?
- Prompt: How would you engage him in behaviour change?
Q4. What preventive health interventions should be discussed?
- Prompt: Which vaccinations are recommended for his age and risk factors?
- Prompt: What additional screening tests should be considered?
Q5. How would you create a management plan and follow-up schedule for Mark?
- Prompt: How often should he be reviewed?
- Prompt: When should further investigations or specialist referral be considered?
THE COMPETENT CANDIDATE
The competent candidate should be able to:
Q1: What are the key health risks and screening priorities for this patient?
The competent candidate should:
- Cardiovascular disease (CVD) risk:
- Strong family history (father had MI at 54).
- Current smoker (15 cigarettes/day for 30 years).
- Borderline hypertension (140/90 mmHg, BMI 29, central obesity).
- Sedentary lifestyle and high processed food intake.
- Requires absolute CVD risk assessment using the Australian CVD risk calculator.
- Diabetes screening:
- Fasting glucose and HbA1c ordered, given BMI and central obesity.
- Cancer screening:
- Colorectal cancer: Needs FOBT or colonoscopy, as per national guidelines for men over 50.
- Prostate cancer: Shared decision-making regarding PSA testing.
- Smoking and alcohol use:
- Smoking cessation intervention required.
- Alcohol use exceeds safe limits.
Q2: How would you assess Mark’s cardiovascular risk and what lifestyle advice would you provide?
The competent candidate should:
- Use the Australian CVD risk calculator to determine absolute risk.
- Blood pressure monitoring: Confirm diagnosis if consistently >140/90 mmHg.
- Lipid profile: Identify dyslipidaemia contributing to risk.
- Lifestyle interventions:
- Diet: Reduce processed foods, increase vegetables, lean proteins.
- Exercise: At least 150 minutes of moderate-intensity exercise per week.
- Smoking cessation: Offer NRT, varenicline, or bupropion, along with behavioural support.
- Alcohol moderation: Limit to ≤10 standard drinks per week, no more than 4 per occasion.
Q3: How would you approach smoking cessation for Mark?
The competent candidate should:
- Assess readiness to quit using motivational interviewing.
- Nicotine dependence assessment: Number of cigarettes per day, withdrawal symptoms.
- Discuss pharmacotherapy:
- First-line: NRT (patch + short-acting) or varenicline.
- Second-line: Bupropion if appropriate.
- Refer to Quitline and behavioural support.
- Arrange follow-up to assess withdrawal symptoms and relapse prevention.
Q4: What preventive health interventions should be discussed?
The competent candidate should:
- Vaccinations: Offer influenza, pneumococcal (if indicated), and COVID-19 booster.
- Cancer screening:
- Colorectal cancer: FOBT or colonoscopy.
- Prostate cancer: PSA test after informed discussion.
- Diabetes prevention: Encourage weight management and glucose monitoring.
Q5: How would you create a management plan and follow-up schedule for Mark?
The competent candidate should:
- 1-month review: Smoking cessation progress, BP check, lifestyle changes.
- 3-month review:
- Review lipids, glucose, and BP.
- Address smoking cessation progress.
- 6-12 months:
- Repeat CVD risk assessment.
- Reinforce cancer screening and vaccinations.
SUMMARY OF A COMPETENT ANSWER
- Identifies key health risks, including CVD, diabetes, and cancer screening needs.
- Uses the Australian CVD risk calculator for cardiovascular assessment.
- Prioritises smoking cessation, diet, and exercise interventions.
- Provides evidence-based preventive care, including vaccinations and screening.
- Develops a structured follow-up plan for ongoing risk management.
PITFALLS
- Not assessing absolute CVD risk using a validated tool.
- Failing to address smoking cessation with structured support.
- Neglecting cancer screening recommendations for men over 50.
- Overlooking alcohol reduction advice and its impact on health risks.
REFERENCES
- RACGP Guidelines for Preventive Activities (Red Book)
- Heart Foundation CVD Risk Calculator
- National Bowel Cancer Screening Program
- Quitline Smoking Cessation Support
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 Engages the patient in shared decision-making regarding lifestyle changes and screening.
2. Clinical Information Gathering and Interpretation
2.1 Takes a structured and hypothesis-driven history to assess health risks.
3. Diagnosis, Decision-Making and Reasoning
3.1 Identifies key risk factors and prioritises appropriate interventions.
4. Clinical Management and Therapeutic Reasoning
4.1 Develops a preventive health strategy tailored to the patient’s risk profile.
5. Preventive and Population Health
5.2 Implements age-appropriate screening and vaccinations.
6. Professionalism
6.3 Addresses patient concerns and barriers to lifestyle change.
7. General Practice Systems and Regulatory Requirements
7.2 Orders appropriate Medicare-funded health assessments and referrals.
9. Managing Uncertainty
9.1 Uses appropriate follow-up intervals to assess health improvements.
10. Identifying and Managing the Patient with Significant Illness
10.3 Recognises red flags requiring further investigation or specialist referral.
Competency at Fellowship Level
☐ CLEARLY BELOW STANDARD
☐ BELOW EXPECTED STANDARD
☐ BORDERLINE
☐ AT EXPECTED STANDARD
☐ ABOVE STANDARD