CCE-CBD-203

CASE INFORMATION

Case ID: PREEMP-2025-001
Case Name: Michael Thompson
Age: 42
Gender: Male
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: A97 (Pre-employment Medical Examination)

COMPETENCY OUTCOMES

Competency DomainCompetency Element
1. Communication and Consultation Skills1.1 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 Interpretation2.3 Conducts a focused occupational health history and examination.
3. Diagnosis, Decision-Making and Reasoning3.1 Assesses fitness for work and identifies occupational health risks.
4. Clinical Management and Therapeutic Reasoning4.4 Provides advice on workplace modifications and reasonable adjustments.
5. Preventive and Population Health5.3 Identifies occupational health risks and promotes workplace safety.
6. Professionalism6.1 Demonstrates ethical practice, including confidentiality in occupational health assessments.
7. General Practice Systems and Regulatory Requirements7.2 Understands medico-legal obligations in workplace health assessments.
9. Managing Uncertainty9.2 Balances patient-centred care with employer requirements in pre-employment medicals.

CASE FEATURES

  • Male patient presenting for a pre-employment medical examination.
  • Applying for a FIFO (Fly-In, Fly-Out) mining role, requiring heavy manual labour.
  • Company requires full medical clearance, including spirometry, audiometry, and cardiovascular fitness.
  • Patient has a history of hypertension and is taking amlodipine 5mg daily.
  • No other significant past medical history, non-smoker, drinks occasionally.
  • Patient is concerned about whether his blood pressure may affect job suitability.
  • Employer has requested drug and alcohol screening, which the patient is nervous about due to social cannabis use 4 weeks ago.

CANDIDATE INFORMATION

INSTRUCTIONS

Review the following patient record summary and scenario.

Your examiner will ask you a series of questions based on this information.

You have 15 minutes to complete this case.

The time for each question will be managed by the examiner.

The time allocation for each question is roughly as follows:

  • 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: Michael Thompson
Age: 42
Gender: Male
Gender Assigned at Birth: Male
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

  • No known allergies.

Medications

  • Amlodipine 5mg daily for hypertension.

Past History

  • Hypertension, diagnosed 2 years ago.
  • No other chronic medical conditions.

Social History

  • FIFO mining job applicant.
  • Occasional alcohol use (4-5 standard drinks per week).
  • No smoking history.
  • Reports past social cannabis use, last use 4 weeks ago.

Family History

  • Father had myocardial infarction at age 54.
  • No history of diabetes or stroke.

Vaccination and Preventative Activities

  • Up to date with routine vaccinations.
  • Last medical check-up 1 year ago.

SCENARIO

Michael Thompson, a 42-year-old male, presents for a pre-employment medical examination as part of the recruitment process for a FIFO mining job. The job requires heavy manual labour in a remote environment, with long shifts in extreme temperatures. The company has requested a full medical clearance, including spirometry, audiometry, cardiovascular assessment, and drug/alcohol screening.

Michael has controlled hypertension on amlodipine and is concerned about how this might impact his job application. He is also nervous about the drug screening because he used cannabis socially 4 weeks ago.

The employer is particularly focused on workplace safety, physical fitness, and cardiovascular risk factors.

EXAMINATION FINDINGS

General Appearance: Well, no acute distress.
Blood Pressure: 142/88 mmHg (repeat 138/86 mmHg).
Heart Rate: 74 bpm, regular.
Respiratory Rate: 16 breaths per minute.
Oxygen Saturation: 99% on room air.
BMI: 27 (overweight range).
Cardiovascular Exam: Dual heart sounds, no murmurs, peripheral pulses intact.
Respiratory Exam: Normal breath sounds, no wheeze.
Neurological Exam: Normal reflexes, power, and coordination.
Audiometry: Mild high-frequency hearing loss in left ear.
Spirometry: Normal lung function.

EXAMINER ONLY INFORMATION

QUESTIONS

Q1. What are the key components of a pre-employment medical examination?

  • Prompt: What specific aspects must be assessed for this job role?
  • Prompt: How do you determine fitness for work?

Q2. How would you assess Michael’s cardiovascular risk and fitness for heavy manual labour?

  • Prompt: What cardiovascular factors are relevant for his job?
  • Prompt: How would you interpret his blood pressure readings?

Q3. What advice would you provide Michael regarding his cannabis use and drug screening?

  • Prompt: What are the implications of past cannabis use in pre-employment testing?
  • Prompt: How would you communicate this sensitively while maintaining professional boundaries?

Q4. What ethical and legal considerations must be addressed in pre-employment medicals?

  • Prompt: How do you balance patient confidentiality with employer requirements?
  • Prompt: What are the medico-legal responsibilities of the GP in this context?

Q5. If Michael is borderline fit for work, what reasonable adjustments or workplace modifications could be considered?

  • Prompt: What factors influence workplace recommendations?
  • Prompt: How would you collaborate with occupational health specialists?

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Q1: What are the key components of a pre-employment medical examination?

A pre-employment medical examination assesses an applicant’s fitness for work in relation to the physical and mental demands of the role. The assessment must be job-specific, focusing on workplace risks while ensuring ethical and legal obligations are met.

Key Components

  1. Comprehensive Occupational Health History
    • Job demands: Heavy manual labour, extreme temperatures, long shifts.
    • Medical conditions: Hypertension—controlled with amlodipine.
    • Medications: Potential impact on job performance (e.g., side effects).
    • Substance use history: Drug and alcohol screening requirements.
    • Previous workplace injuries: Any history of musculoskeletal conditions or chronic disease affecting fitness for duty.
  2. Physical Examination
    • Cardiovascular fitness: BP, HR, auscultation, history of exertional symptoms.
    • Respiratory health: Spirometry if exposure to dust/fumes is expected.
    • Audiometry: Hearing protection and job suitability.
    • Musculoskeletal assessment: Range of motion, strength, flexibility, injury risks.
    • BMI and weight considerations: Risk of heat stress and physical workload.
  3. Workplace Risk Factors
    • FIFO setting: Mental health considerations (isolation, fatigue management).
    • Occupational hazards: Noise exposure, respiratory risks, physical exertion.
    • Regulatory compliance: Fitness to work under Work Health and Safety (WHS) standards.
  4. Legal and Ethical Considerations
    • Confidentiality: Information shared only with consent.
    • Informed consent: Candidate must understand the process and implications.
    • Medical suitability vs. discrimination: Ensure fairness in assessment.
  5. Counselling and Health Promotion
    • Modifiable risk factors: Blood pressure control, weight management.
    • Advice on drug and alcohol testing: Implications of previous cannabis use.
    • Job-specific fitness recommendations: Adaptations or modifications.

SUMMARY OF A COMPETENT ANSWER

  • Takes a structured occupational history, linking medical conditions to job demands.
  • Performs targeted physical and functional assessments relevant to the role.
  • Demonstrates awareness of WHS regulations and ethical considerations.
  • Provides clear, job-related advice while maintaining confidentiality.

PITFALLS

  • Failing to assess the specific job requirements and workplace risks.
  • Overlooking key medical conditions that could impact fitness for work.
  • Providing a generic medical assessment rather than a job-specific evaluation.
  • Not discussing the candidate’s rights and confidentiality in relation to employer reporting.

REFERENCES

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

2.3 Conducts a focused occupational health history and examination.

3. Diagnosis, Decision-Making and Reasoning

3.1 Assesses fitness for work and identifies occupational health risks.

4. Clinical Management and Therapeutic Reasoning

4.4 Provides advice on workplace modifications and reasonable adjustments.

5. Preventive and Population Health

5.3 Identifies occupational health risks and promotes workplace safety.

6. Professionalism

6.1 Demonstrates ethical practice, including confidentiality in occupational health assessments.

7. General Practice Systems and Regulatory Requirements

7.2 Understands medico-legal obligations in workplace health assessments.

9. Managing Uncertainty

9.2 Balances patient-centred care with employer requirements in pre-employment medicals.

Competency at Fellowship Level

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