CCE-CBD-162

EXAMINER ONLY INFORMATION

QUESTIONS

Q1. What are your immediate concerns and how will you address them?

• Prompt: Discuss glaucoma progression and risk of irreversible vision loss
• Prompt: Explain the impact on driving and independence
• Prompt: Address adherence to treatment

Q2. What is your management plan for Alan’s glaucoma?

• Prompt: Outline pharmacological and non-pharmacological strategies
• Prompt: Discuss referral options and rural health resources
• Prompt: Consider multidisciplinary care

Q3. How would you assess and address Alan’s concerns about driving and independence?

• Prompt: Discuss fitness to drive requirements (Austroads guidelines)
• Prompt: Plan for practical supports and community resources
• Prompt: Communicate sensitively about driving safety and legal responsibilities

Q4. What preventive health strategies would you recommend for Alan?

• Prompt: Diabetes and cardiovascular disease management
• Prompt: Fall prevention considering vision loss
• Prompt: Vaccinations and other chronic disease checks

Q5. How would you engage Alan in long-term self-management of his condition?

• Prompt: Discuss education about glaucoma and treatment adherence
• Prompt: Explore barriers to care in a rural setting
• Prompt: Involve family or support networks if appropriate

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Q1: What are your immediate concerns and how will you address them?

Immediate Concerns:

• Progression of glaucoma leading to irreversible vision loss.
• Safety concerns, including falls risk and driving ability.
• Adherence to treatment, specifically eye drop compliance.
• Social isolation and loss of independence, especially in a rural setting.

Approach:

• Acknowledge Alan’s concerns regarding his vision and independence.
• Explain that glaucoma damage is irreversible, but progression can be slowed with appropriate management.
• Assess current vision and visual field impairment; confirm intraocular pressure (IOP) is suboptimal.
• Emphasise the critical role of strict adherence to timolol eye drops, explaining their role in reducing IOP.
• Discuss the implications for driving, referencing Austroads fitness to drive guidelines. Advise that Alan may need a specialist review to assess whether he meets legal requirements.
• Explore support options, including telehealth ophthalmology consults or assistance with transport to appointments.
• Document the conversation, including the risks and shared decision-making process.

Q2: What is your management plan for Alan’s glaucoma?

Pharmacological Management:

• Ensure adherence to timolol eye drops. Review administration technique.
• Consider adding a prostaglandin analogue (e.g., latanoprost) if IOP remains elevated despite compliance.
• Check for contraindications to additional medications (e.g., asthma with beta-blockers).

Non-Pharmacological and Systems Approach:

• Urgently refer Alan back to his ophthalmologist for specialist review and potential laser trabeculoplasty.
• Explore telehealth options given his rural location.
• Arrange local optometrist monitoring in collaboration with ophthalmology.

Support Services:

• Discuss My Aged Care assessment for transport and support services.
• Explore vision support programs (e.g., Vision Australia).

Education:

• Explain the chronic nature of glaucoma and the need for lifelong monitoring and treatment.
• Provide written material and recommend reliable online resources.

Q3: How would you assess and address Alan’s concerns about driving and independence?

Assessment:

• Review his current vision status, including visual acuity and fields.
• Use Austroads Assessing Fitness to Drive standards: visual acuity ≥6/12 and adequate visual fields (no significant peripheral field loss).
• Discuss the need for a specialist report from his ophthalmologist regarding fitness to drive.

Addressing Concerns:

• Be empathetic about how losing his licence may affect his life.
• Explore alternatives: community transport, family/friend support, volunteer driver programs in rural areas.
• Encourage continued engagement in social activities, promoting mental health and quality of life.
• Reassure that if his vision can be improved or stabilised, he may retain his licence.

Q4: What preventive health strategies would you recommend for Alan?

• Diabetes Management: Ensure HbA1c ≤7%, lipid and BP control.
• Cardiovascular Risk: Assess CVD risk and address modifiable factors.
• Falls Prevention: Home safety assessment, vitamin D, and exercise to improve balance.
• Vaccination: Confirm up-to-date influenza, pneumococcal, and COVID-19 vaccines.
• Chronic Disease Checks: Diabetic retinopathy screening, foot checks, renal function monitoring.
• Mental Health: Screen for depression related to chronic illness and potential loss of independence.

Q5: How would you engage Alan in long-term self-management of his condition?

• Provide education about glaucoma, treatment adherence, and implications of poor control.
• Discuss strategies to improve compliance: setting alarms, involving a family member or carer, simplifying routines.
• Explore barriers to care, including transport and appointment access. Offer telehealth where possible.
• Collaborate with ophthalmologist and optometrist to ensure shared care.
• Provide resources for emotional support and peer networks.
• Promote regular chronic disease reviews in general practice.

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SUMMARY OF A COMPETENT ANSWER

• Identifies progression risk of glaucoma and addresses immediate vision concerns.
• Understands Austroads guidelines and explains fitness to drive sensitively.
• Provides a comprehensive management plan, including medications, referral, and supports.
• Emphasises preventive care and multidisciplinary approach.
• Actively involves the patient in self-management and addresses rural healthcare challenges.

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PITFALLS

• Failing to recognise glaucoma progression and delay referral.
• Not discussing fitness to drive or avoiding the topic.
• Ignoring treatment non-compliance without investigating the cause.
• Overlooking the impact on independence and mental health.
• Not offering practical solutions for rural challenges (e.g., telehealth, transport).

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REFERENCES

• RACGP Guidelines
• Austroads Assessing Fitness to Drive 2022
• Glaucoma Australia
• Vision Australia

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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 Communication is appropriate to the person and the sociocultural context.
1.2 Engages the patient to gather information about their symptoms, ideas, concerns, expectations of healthcare and the full impact of their illness experience on their lives.
1.4 Communicates effectively in routine and difficult situations.

2. Clinical Information Gathering and Interpretation

2.1 Gathers and interprets findings accurately and comprehensively.

3. Diagnosis, Decision-Making and Reasoning

3.1 Demonstrates diagnostic reasoning including managing differential diagnoses.

4. Clinical Management and Therapeutic Reasoning

4.1 Develops and implements patient-centred management plans.

5. Preventive and Population Health

5.1 Provides care that addresses prevention and early detection of disease.

6. Professionalism

6.1 Demonstrates ethical behaviour and professional integrity.

7. General Practice Systems and Regulatory Requirements

7.1 Understands systems to ensure patient safety and quality care.

9. Managing Uncertainty

9.1 Recognises and manages diagnostic uncertainty.

10. Identifying and Managing the Patient with Significant Illness

10.1 Recognises potentially life-threatening or serious conditions.

12. Rural Health Context (RH)

RH1.1 Provides care relevant to the rural context, including limited resources and referral pathways.

Competency at Fellowship Level

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