CCE-CBD-178

EXAMINER ONLY INFORMATION

QUESTIONS

Q1. How would you approach Michael’s concerns and gather relevant information?

Prompt: Explore his understanding of Parkinson’s disease
Prompt: Identify specific concerns, ideas, and expectations
Prompt: Explore impact on lifestyle and mental health

Q2. What are the possible management options for Michael, and how would you explain them?

Prompt: Discuss medication initiation (e.g., Levodopa)
Prompt: Explain role of allied health (physio, OT, speech)
Prompt: Consider non-pharmacological approaches

Q3. How would you manage Michael’s concerns about driving and independence?

Prompt: Assess fitness to drive
Prompt: Explain Austroads guidelines and notification requirements
Prompt: Provide support options (e.g., community transport)

Q4. What preventive health measures and safety-netting advice would you provide?

Prompt: Falls risk assessment and home safety
Prompt: Vaccinations (Influenza, Pneumococcal, Herpes Zoster)
Prompt: Plan for regular review and monitoring

Q5. How would you address the psychosocial impact on Michael and his wife?

Prompt: Explore caregiver burden and coping strategies
Prompt: Provide resources (support groups, counselling)
Prompt: Discuss advance care planning sensitively

THE COMPETENT CANDIDATE

The competent candidate should be able to:

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Q1: How would you approach Michael’s concerns and gather relevant information?

Answer:

In approaching Michael’s concerns, it is essential to establish a respectful and empathetic communication style. Start by acknowledging his diagnosis and expressing empathy for the emotional impact it may have.

Explore understanding and knowledge:

• “Michael, can you share with me your understanding of Parkinson’s disease?”
• Clarify misconceptions gently and provide reassurance.

Identify specific concerns:

• Elicit his ideas, concerns, and expectations: “What are your main worries or concerns about the diagnosis?”
• Explore his fear of dependence, particularly on his wife, and concerns about driving.

Assess psychosocial impact:

• Ask about mood and coping strategies: “How are you feeling emotionally since receiving the diagnosis?”
• Explore potential anxiety, depression, and social withdrawal.
• Understand his daily functional impact: difficulties with fine motor tasks, personal care, or hobbies.

Support network:

• Enquire about his family and social support, particularly his wife’s coping.
• Screen for caregiver stress.

Lifestyle factors:

• Assess current activities, community engagement, exercise levels, and diet.

Summarise key concerns and provide an agenda for the consultation.

Key skills demonstrated: Active listening, open-ended questioning, empathy, and patient-centred care.

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Q2: What are the possible management options for Michael, and how would you explain them?

Answer:

Pharmacological Management:

• Introduce Levodopa/Carbidopa as the first-line treatment, particularly for bradykinesia and rigidity.
• Discuss potential side effects: dyskinesia, nausea, orthostatic hypotension.
• Consider dopamine agonists or MAO-B inhibitors as alternatives or adjuncts depending on progression and side effect profiles.

Non-Pharmacological Management:

• Referral to physiotherapy for gait, balance, and strength exercises.
• Occupational therapy for fine motor skills, home safety, and adaptive devices.
• Speech therapy for voice and swallowing issues.

Lifestyle modifications:

• Encourage regular exercise (tai chi, walking), good nutrition, and hydration.
• Cognitive stimulation through reading or social engagement.

Education and Support:

• Provide Parkinson’s Australia resources and support groups.
• Discuss prognosis honestly but optimistically, focusing on maintaining function and independence.

Document management plans and arrange regular follow-up.

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Q3: How would you manage Michael’s concerns about driving and independence?

Answer:

Assess Fitness to Drive:

• Use a clinical judgement approach; observe functional abilities and cognition.
• Austroads guidelines recommend notification to licensing authorities if fitness is in question.

Discuss the Legal and Ethical Obligations:

• Inform Michael he may be required to have an off-road or on-road driving assessment.
• Explain that the ultimate decision rests with the state licensing authority.

Address Independence Concerns:

• Explore alternatives such as community transport services.
• Reinforce maintaining mobility and independence through public transport, taxi subsidies.

Provide Reassurance and a Follow-Up Plan:

• Emphasise the aim is safe driving for him and others.
• Offer support through driving assessments and counselling as needed.

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Q4: What preventive health measures and safety-netting advice would you provide?

Answer:

Falls Prevention:

• Conduct a falls risk assessment.
• Recommend home modifications (e.g., rails, removing trip hazards).

Vaccinations:

• Review status: offer pneumococcal, annual influenza, and shingles vaccinations.

Bone Health:

• Assess risk of osteoporosis; consider DEXA scan, ensure adequate calcium and vitamin D.

Safety-Netting:

• Discuss signs of disease progression (e.g., worsening mobility, swallowing issues).
• Provide clear instructions on when to seek help.
• Arrange regular reviews to monitor therapy effectiveness and side effects.

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Q5: How would you address the psychosocial impact on Michael and his wife?

Answer:

Explore Emotional Wellbeing:

• Assess for depression, anxiety, and social withdrawal in both Michael and his wife.

Support for the Caregiver:

• Validate his wife’s experience.
• Suggest respite care, carer support services (Carer Gateway), and local carer support groups.

Resources:

• Provide information on Parkinson’s disease support groups and counselling services.
• Offer advance care planning discussions when appropriate.

Encourage Open Communication:

• Facilitate conversations between Michael and his family about his wishes and concerns for the future.

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SUMMARY OF A COMPETENT ANSWER

• Explores Michael’s understanding and psychosocial impact of Parkinson’s disease.
• Discusses pharmacological and non-pharmacological management.
• Addresses driving safety and independence empathetically.
• Implements preventive health measures and safety-netting advice.
• Supports the patient and caregiver through resources and planning.

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PITFALLS

• Failure to explore psychosocial concerns or caregiver stress.
• Overlooking the legal implications and guidelines regarding fitness to drive.
• Neglecting to involve allied health professionals in the management plan.
• Providing unclear safety-netting advice or lacking a follow-up plan.

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REFERENCES

• RACGP Guidelines for preventive activities in general practice (“Red Book”)
• Parkinson’s Australia
• Austroads Fitness to Drive Guidelines

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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, 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 about health and health determinants.

3. Diagnosis, Decision-Making and Reasoning

3.1 Generates and tests hypotheses and makes evidence-based decisions.

4. Clinical Management and Therapeutic Reasoning

4.1 Develops and implements management plans.
4.2 Provides patient-centred management.

5. Preventive and Population Health

5.1 Provides healthcare that anticipates and addresses social determinants of health.

6. Professionalism

6.1 Demonstrates ethical behaviour and professional integrity.

7. General Practice Systems and Regulatory Requirements

7.1 Uses quality and safety systems in practice.

9. Managing Uncertainty

9.1 Manages uncertainty in clinical practice.

10. Identifying and Managing the Patient with Significant Illness

10.1 Provides appropriate management for patients with complex health needs.

12. Rural Health Context (RH)

RH1.1 Provides comprehensive care in rural and remote communities.

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Competency at Fellowship Level

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