CCE-CBD-202

EXAMINER ONLY INFORMATION

QUESTIONS

Q1. What are the key components of a travel consultation for this patient?

• Prompt: What specific aspects of John’s travel itinerary are relevant for risk assessment?
• Prompt: How would you assess his need for vaccinations and prophylaxis?

Q2. What vaccinations would you recommend for John based on his travel plans?

• Prompt: Which vaccinations are required, recommended, or optional?
• Prompt: How would you counsel John on vaccine side effects and cost considerations?

Q3. What are the malaria and vector-borne disease prevention strategies for John?

• Prompt: What factors influence malaria prophylaxis recommendations?
• Prompt: What non-pharmacological measures can reduce his risk of vector-borne diseases?

Q4. What advice would you provide about food, water, and general travel health?

• Prompt: How can John reduce his risk of traveller’s diarrhoea?
• Prompt: What emergency medications might be useful to carry?

Q5. How would you address John’s concerns about vaccine side effects and costs?

• Prompt: How would you apply a shared decision-making approach in this scenario?
• Prompt: What resources or travel clinics could you recommend for further information?

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Q1: What are the key components of a travel consultation for this patient?

A competent candidate would conduct a structured and comprehensive travel consultation addressing key risks associated with John’s travel itinerary.

Key Components of a Travel Consultation

1. Comprehensive Travel History:
   • Destinations: Thailand, Cambodia, Indonesia – noting tropical climate and endemic diseases.
   • Planned activities: City sightseeing, jungle trekking, scuba diving – impacting vaccine and prophylaxis needs.
   • Duration of travel: Three weeks – affecting the timing of vaccine schedules and prophylaxis requirements.
   • Accommodation type: Hotels vs. hostels vs. rural areas – influencing risk exposure to vector-borne diseases.
   • Season of travel: Rainy vs. dry season – affecting mosquito-borne disease prevalence.
2. Health Risk Assessment:
   • Pre-existing conditions: None, but lifestyle factors (outdoor activities) increase exposure risk.
   • Vaccination status: Up to date on routine vaccines but lacking travel-specific vaccinations.
   • Medication review: No regular medications, no known drug allergies.
   • Previous travel experiences: No prior travel to high-risk areas.
3. Preventive Health Measures:
   • Vaccination assessment: Hepatitis A, Typhoid, Japanese Encephalitis (depending on risk), and Rabies (considering jungle trekking).
   • Malaria risk stratification: Consideration of prophylaxis based on time spent in high-risk areas.
   • Vector-borne disease prevention: Strategies for dengue fever, malaria, chikungunya (mosquito repellents, protective clothing).
   • Food and water safety: Avoidance of contaminated food/water to prevent traveller’s diarrhoea.
   • Travel insurance: Ensuring comprehensive medical cover, including evacuation.
4. Counselling and Shared Decision-Making:
   • Discuss vaccine side effects and benefits to alleviate concerns.
   • Address cost concerns by prioritising essential vaccines.
   • Provide an emergency travel kit including first-aid, electrolytes, antibiotics (if warranted).

SUMMARY OF A COMPETENT ANSWER

• Thorough travel history covering destinations, duration, and activities.
• Risk assessment based on itinerary and medical history.
• Clear recommendations for vaccinations, prophylaxis, and general travel health.
• Effective communication addressing patient concerns and promoting shared decision-making.

PITFALLS

• Failing to take a comprehensive travel history, leading to missed risks.
• Neglecting to consider cost and patient concerns when recommending vaccinations.
• Not providing preventive strategies beyond vaccinations (e.g., insect bite prevention).
• Omitting discussion on travel insurance and access to healthcare abroad.

REFERENCES

• Australian Immunisation Handbook
• Travel Health Guidelines (CDC)
• WHO International Travel & Health
• RACGP Guidelines on Travel Medicine

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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 Communicates effectively and appropriately to provide quality care.
1.2 Uses effective health education strategies to promote health and wellbeing.

2. Clinical Information Gathering and Interpretation

2.1 Takes a comprehensive travel history, including destination, itinerary, and planned activities.

3. Diagnosis, Decision-Making and Reasoning

3.2 Identifies risks associated with travel and applies clinical reasoning to preventive health measures.

4. Clinical Management and Therapeutic Reasoning

4.3 Develops an appropriate vaccination and prophylaxis plan based on travel itinerary.

5. Preventive and Population Health

5.1 Provides travel health education, including food and water safety, vector-borne disease prevention, and personal safety abroad.

6. Professionalism

6.2 Provides ethical and patient-centred care, considering individual risk factors and personal preferences.

7. General Practice Systems and Regulatory Requirements

7.3 Ensures documentation of vaccinations and medical clearance for travel as per regulatory requirements.

9. Managing Uncertainty

9.1 Addresses uncertainties related to emerging travel health risks, including new outbreaks or vaccine shortages.

Competency at Fellowship Level

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