CCE-CBD-172

EXAMINER ONLY INFORMATION

QUESTIONS

Q1. How would you explain Sarah’s nutritional needs during pregnancy and address her concerns about gestational diabetes?

• Prompt: Explain dietary recommendations in pregnancy.
• Prompt: Discuss gestational diabetes prevention strategies.

Q2. What advice would you give Sarah about physical activity in pregnancy?

• Prompt: Provide exercise guidelines for pregnant women.
• Prompt: Address safety and benefits.

Q3. How would you support Sarah’s emotional wellbeing and address her concerns about isolation?

• Prompt: Explore her social support network.
• Prompt: Offer resources and referrals for antenatal classes and peer support.

Q4. What factors need to be considered when planning Sarah’s delivery location, and how would you approach this discussion?

• Prompt: Discuss risks and benefits of rural versus tertiary delivery.
• Prompt: Address Sarah’s preferences and safety concerns.

Q5. What preventive health activities are relevant at this stage of Sarah’s pregnancy?

• Prompt: Address travel and emergency plans in rural settings.
• Prompt: Discuss vaccinations, screening tests, and health promotion.

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Q1: How would you explain Sarah’s nutritional needs during pregnancy and address her concerns about gestational diabetes?

Answer:

Introduction
Sarah, it’s great you’re thinking about your nutrition and health during pregnancy. Let’s go through what’s recommended and how we can lower your risk for gestational diabetes (GDM).

Nutritional Requirements

• Pregnancy increases nutritional needs, but energy requirements rise only modestly. At 28 weeks, you need an extra 300 kcal/day.
• Focus on balanced meals from the five food groups:
  • Vegetables and legumes/beans: Aim for 5 servings daily.
  • Fruits: 2 servings daily.
  • Whole grains: Prefer high-fibre cereals, breads, and grains.
  • Lean meats, fish, eggs, nuts, seeds, legumes: Iron and protein are important.
  • Dairy or alternatives: Ensure adequate calcium.

Managing Weight Gain

• Recommended weight gain for BMI 28 is 7-11.5 kg over the pregnancy.
• Monitor portion sizes and choose low-GI, high-fibre carbs to maintain stable blood glucose.

Gestational Diabetes Prevention

• Your family history increases your risk of GDM.
• Strategies to minimise risk:
  • Low-GI diet: e.g., wholegrain bread, brown rice, oats.
  • Limit sugary foods: Reduce soft drinks, cakes, and lollies.
  • Healthy fats: Avocados, olive oil, nuts instead of saturated fats.
  • Regular meals/snacks: Prevent large fluctuations in blood glucose.
• Ensure adequate hydration and fibre to prevent constipation.

Practical Rural Considerations

• Access to fresh produce can be challenging—consider:
  • Buying frozen vegetables/fruits (nutrient retention is excellent).
  • Meal planning to minimise waste and maximise variety.
• Community or online dietitian consultations may be an option.

Closing
We will also screen you for GDM at 28 weeks via an oral glucose tolerance test (OGTT). If issues arise, we’ll work together on a plan.

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Q2: What advice would you give Sarah about physical activity in pregnancy?

Answer:

Introduction
Sarah, staying active during pregnancy benefits both you and your baby. Let’s discuss what’s safe and helpful at this stage.

Physical Activity Guidelines

• 150-300 minutes of moderate-intensity activity per week, e.g., 30 minutes most days.
• Suitable activities include:
  • Walking (gentle but effective)
  • Swimming
  • Prenatal yoga or Pilates
  • Stationary cycling

Precautions

• Avoid contact sports and high-risk falls activities (e.g., horse riding).
• Be mindful of balance changes and joint laxity due to relaxin hormone.
• Watch for warning signs to stop exercise: vaginal bleeding, dizziness, chest pain, contractions.

Benefits

• Helps regulate weight gain.
• Lowers GDM and hypertension risk.
• Improves mood, reduces anxiety and fatigue.
• Prepares body for labour.

Practical Strategies in a Rural Setting

• Walk on flat, safe surfaces around the farm.
• Consider virtual classes if antenatal fitness options are limited locally.

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Q3: How would you support Sarah’s emotional wellbeing and address her concerns about isolation?

Answer:

Introduction
Sarah, it’s normal to feel isolated, especially in rural areas. Let’s talk about support systems and strategies.

Explore Support Network

• Partner and family involvement.
• Friends in the community.

Referral Options

• Local antenatal classes: Check with the hospital or GP clinic.
• Online forums: E.g., Raising Children Network, Pregnancy Birth and Baby Helpline.
• Mother’s groups: Virtual or in-person via the local community centre or child health nurse.

Emotional Wellbeing

• Screening for antenatal depression/anxiety using EPDS if indicated.
• Encourage open communication with partner and healthcare providers.

Follow-up

• Regular check-ins at antenatal appointments to monitor emotional health.

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Q4: What factors need to be considered when planning Sarah’s delivery location, and how would you approach this discussion?

Answer:

Factors to Consider

• Risk status: Currently low-risk, no complications.
• Distance to tertiary hospital: 120 km—consider emergency transfer feasibility.
• Rural birthing unit capabilities: Staffing, anaesthetic services, emergency caesarean access.
• Patient preferences: Values, cultural considerations.

Discussion Approach

• Provide balanced information on risks/benefits of rural vs tertiary birth.
• Develop a birth plan, including:
  • Early signs of labour: when to present.
  • Emergency transfer plan if needed.

Informed Consent

• Respect patient autonomy while ensuring safety.

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Q5: What preventive health activities are relevant at this stage of Sarah’s pregnancy?

Answer:

Vaccination

• Pertussis booster now (at 28 weeks).
• Review influenza vaccine status.
• Confirm COVID-19 booster timing.

Screening Tests

• OGTT for GDM.
• Anaemia screen (FBE).
• Ferritin, Vitamin D if risk factors exist.

Health Promotion

• Discuss perineal massage from 34 weeks.
• Discuss pelvic floor exercises.

Travel Planning

• Travel distance to birthing services.
• Emergency contacts, ambulance coverage.

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SUMMARY OF A COMPETENT ANSWER

• Nutritional counselling focused on balanced diet, low-GI foods, and weight management.
• Physical activity guidance based on safe, moderate exercise with rural considerations.
• Emotional wellbeing support through exploring social support and mental health screening.
• Birth planning considering risks of rural birth vs tertiary care.
• Preventive health: vaccination updates, screening tests, health promotion strategies.

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PITFALLS

• Failing to screen for emotional wellbeing, missing antenatal anxiety/depression.
• Overlooking travel logistics and birth planning in rural settings.
• Providing general dietary advice without considering Sarah’s rural access challenges.
• Not addressing vaccination needs at the appropriate gestation.
• Ignoring physical activity risks related to balance and joint laxity in pregnancy.

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REFERENCES

• RACGP Guidelines for Preventive Activities in General Practice (“Red Book”)
• Australian Pregnancy Care Guidelines
• Raising Children Network on Raising Children Pregnancy
• RANZCOG Antenatal Care Guidelines on RANZCOG Antenatal

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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 information from history-taking and examination.
2.2 Selects and interprets appropriate investigations.

3. Diagnosis, Decision-Making and Reasoning

3.1 Generates and prioritises hypotheses about health problems.

4. Clinical Management and Therapeutic Reasoning

4.1 Develops and implements management plans collaboratively.
4.2 Provides appropriate patient education and counselling.

5. Preventive and Population Health

5.1 Provides care that addresses prevention and early detection of disease.
5.2 Provides care that addresses the health needs of the community.

6. Professionalism

6.1 Demonstrates respect, compassion, empathy and caring in patient care.

7. General Practice Systems and Regulatory Requirements

7.1 Uses practice systems effectively and safely.

9. Managing Uncertainty

9.1 Manages diagnostic uncertainty effectively.

12. Rural Health Context (RH)

RH1.1 Considers rural context and resource limitations in patient care decisions.

Competency at Fellowship Level

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