CCE-CE-002

CASE INFORMATION

Case ID: 0024
Case Name: Henry Thompson
Age: 70
Gender: Male
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: A44 (Preventive immunisation/medication), A35 (General health maintenance), A27 (Risk factor assessment)

COMPETENCY OUTCOMES

Competency DomainCompetency Element
1. Communication and Consultation Skills1.1 Tailors communication to the patient’s health literacy level.
1.2 Engages the patient in shared decision-making regarding preventive care.
1.4 Addresses patient concerns effectively regarding vaccines and screening.
2. Clinical Information Gathering and Interpretation2.1 Elicits relevant history related to vaccination and screening eligibility.
2.3 Identifies risk factors that influence screening recommendations.
3. Diagnosis, Decision-Making and Reasoning3.2 Justifies recommended screening tests based on guidelines.
3.3 Weighs benefits and risks of vaccination for an elderly patient.
4. Clinical Management and Therapeutic Reasoning4.1 Provides evidence-based recommendations for age-appropriate immunisations and screenings.
4.3 Develops a personalised preventive health plan.
5. Preventive and Population Health5.1 Applies national screening and vaccination guidelines.
5.3 Considers patient-specific preventive strategies based on lifestyle and comorbidities.
6. Professionalism6.2 Provides unbiased and evidence-based preventive care.
7. General Practice Systems and Regulatory Requirements7.1 Adheres to Australian immunisation and screening guidelines.

CASE FEATURES

  • 70-year-old man attending for a routine check-up.
  • Patient is otherwise well but has some doubts about vaccines and screening.
  • Requires age-appropriate immunisations (e.g., influenza, pneumococcal, shingles).
  • Requires recommended cancer screenings (e.g., bowel, prostate).
  • May have cardiovascular risk factors requiring lipid/glucose screening.
  • The candidate must engage in shared decision-making while addressing concerns.

INSTRUCTIONS

You have 15 minutes to complete this case.

You should treat this consultation as if it is face-to-face.

You are not required to perform an examination.

A patient record summary is provided for your information.

Perform the following tasks:

  1. Take an appropriate history.
  2. Discuss age-appropriate immunisations.
  3. Explain recommended health screenings.
  4. Address the patient’s concerns.

SCENARIO

Henry Thompson, a 70-year-old retired accountant, presents for a routine check-up. He has no major complaints but wants to ensure he is “staying on top” of his health. He has hypertension (well-controlled with medication) and a history of mild osteoarthritis. His father had a heart attack at 72, and his mother had bowel cancer in her late 70s. He does not smoke and drinks alcohol socially. Henry is unsure about vaccines.

PATIENT RECORD SUMMARY

Patient Details

Name: Henry Thompson
Age: 70
Gender: Male
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

  • Nil known

Medications

  • Amlodipine 5mg daily (for hypertension)

Past History

  • Hypertension (diagnosed 10 years ago)
  • Osteoarthritis (mild, knee pain occasionally)

Social History

  • Retired accountant
  • Non-smoker, drinks 2-3 standard drinks on weekends

Family History

  • Father had a heart attack at 72
  • Mother had bowel cancer in her late 70s

Vaccination and Preventive Activities

  • Influenza: Uncertain, last vaccine was “a few years ago”
  • Pneumococcal: Unsure if he has had it
  • COVID-19 booster: Last dose was over a year ago

ROLE PLAYER INSTRUCTIONS

Just like a consultation with a doctor, the candidate will ask you a series of questions.
The OPENING LINE is always to be said exactly as written. This is the only part of the script
which will be the same for all candidates. Where the candidate goes after the opening line is
up to them.

The remainder of the information is to be given based on the questions asked by the
candidate.

The information in the following script are core pieces of information. The core pieces of
information will not necessarily follow the order in the script but should be given when cued
by the candidate’s question.

GENERAL INFORMATION can be given relatively freely. After the opening line, most
candidates will ask an open question like “Can you tell me more about that?” You can provide
the GENERAL INFORMATION in response to that sort of question.

SPECIFIC INFORMATION should only be given when the candidate asks a relevant question.
Candidates don’t need to ask for all the information in the SPECIFIC INFORMATION section,
but all the relevant information is given there should they want to.

Each line or dot point in the SPECIFIC INFORMATION section is an appropriate chunk of
information which can be provided to the candidate when asked a relevant question.

Do not give extra information than asked.

Do not provide details which are not given in the information chunks (i.e.: do not elaborate
or ad-lib).

If the candidate asks a question that is not given in the script, the best way to respond is with
a generic response indicating there is no problem. For example:

Candidate: “How many hours do you sleep?”
Response: “I’m sleeping fine.” / “I don’t have any concerns about my sleep.”

The case may have specific QUESTIONS to ask the candidate. You can start asking the
QUESTIONS if the candidate asks about your ideas or concerns or questions.

Ask the other questions in a conversational way. You do not need to ask all the questions. The
aim should be to ask most of the questions but without interrupting the candidate.

The Patient Record Summary is also included. This is not part of the script but is included for
your general information.

If you need help in understanding any of the medical information in the script, ask the College
examiner who will be with you, and they can help to explain the terms or the conditions.

Opening Line

“I’m just here for a general check-up, Doc. Want to make sure I’m doing the right things for my health.”

General Information

  • You feel well overall and have no major complaints.
  • You’re not on many medications, just one for blood pressure.
  • You’re not sure what vaccines or screening tests you need.

Specific Information (Only Reveal When Asked)

Background Information

  • You exercise occasionally (walks with wife), eat reasonably well, and don’t smoke.
  • You’ve never had a heart attack or stroke but your father had a heart attack in his 70s.
  • You’ve never had diabetes but don’t know if you should be checked for it.
  • You drink alcohol socially – about 2–3 beers on the weekend.

Vaccination History & Concerns

  • You think you had the flu vaccine a few years ago, but you’re not sure when.
  • You don’t know if you’ve ever had the pneumococcal vaccine.
  • You never had the shingles vaccine because your friend told you he had a “bad reaction” to it (felt really sick for a week).
  • You got the COVID vaccine last year, but you’re not sure if you need another one.
  • You don’t mind getting vaccines but just want to know if they are necessary.

Cancer Screening History & Concerns

  • You had a colonoscopy years ago, but don’t recall any follow-ups.
  • You never had a prostate test because you’ve never had symptoms.
  • You spend a lot of time outdoors (gardening, walking), but have never had a full skin check.
  • You’re not too worried about cancer because you feel healthy, but want to know what’s recommended.

Cardiovascular & Metabolic Screening Concerns

  • Your father had a heart attack at 72, so you wonder if you should get checked.
  • You’re not sure if you need cholesterol or diabetes testing.
  • You take amlodipine for high blood pressure but haven’t had a recent heart check-up.
  • You don’t have chest pain or breathlessness, but sometimes you feel tired after long walks.

Emotional & Behavioural Cues

  • You are open to advice but want explanations.
  • You don’t like unnecessary tests but will follow reasonable recommendations.
  • You trust doctors, but you want to know why something is necessary before agreeing.
  • If the doctor pushes too hard, you may say: “Look, I just don’t want to do tests for the sake of it.”
  • If the doctor explains things well, you may say: “That makes sense. I’ll go ahead with it.”

Patient Expectations

  • You expect a clear explanation about what screening tests and vaccines you need.
  • You want to know why each test is recommended, not just a list of things to do.
  • You want the doctor to address your concerns, especially about the shingles vaccine and prostate cancer screening.

Questions You Might Ask

  1. “Do I really need the shingles vaccine? I’ve heard it can make you feel sick.”
  2. “I feel fine, so why do I need all these tests?”
  3. “Is prostate screening necessary if I don’t have symptoms?”
  4. “How do I know if I have high cholesterol or diabetes?”
  5. “I’ve heard bowel cancer tests are messy. Is there an easier way?”

How to Respond to Different Approaches

  • If the doctor is clear and explains well, you are cooperative and will agree to necessary tests and vaccines.
  • If the doctor rushes through recommendations without explaining, you may say: “That sounds like a lot, do I really need all of this?”
  • If the doctor asks about your health goals, you will say: “I just want to stay healthy and independent as I get older.”
  • If the doctor mentions family history, you will say: “Yeah, my dad had a heart attack, but I don’t have any symptoms, so I never worried about it.”

Final Thoughts

  • You want to stay healthy and independent, but you don’t want unnecessary medical interventions.
  • If the doctor explains things well, you will say: “Thanks, Doc. This was helpful.”
  • If the doctor is unclear, you may say: “I think I’ll think about it and get back to you.”

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take an appropriate history, including vaccination status, family history, and any risk factors influencing screening eligibility.

The competent candidate should:

  • Elicit a comprehensive history regarding previous vaccinations (influenza, pneumococcal, shingles, COVID-19).
  • Identify family history of cancers (e.g., bowel, prostate) and cardiovascular disease.
  • Assess lifestyle risk factors (smoking, alcohol intake, physical activity, diet).
  • Explore any barriers or hesitations regarding immunisation or screening.
  • Clarify the patient’s prior experience with preventive health measures.

Task 2: Discuss age-appropriate immunisations, including indications, contraindications, and potential side effects.

The competent candidate should:

  • Explain that, per the Australian Immunisation Handbook, the patient is eligible for:
    • Annual influenza vaccine (recommended for those >65 years).
    • Pneumococcal vaccine (13-valent conjugate followed by 23-valent polysaccharide).
    • Shingles vaccine (Shingrix) – recommended for adults ≥65 years.
    • COVID-19 booster if last dose was >6 months ago.
  • Address concerns about vaccine side effects, providing reassurance based on evidence.
  • Check for contraindications (e.g., allergy, immunocompromised status).

Task 3: Explain recommended health screenings, including rationale, benefits, and frequency.

The competent candidate should:

  • Recommend bowel cancer screening every 2 years using an immunochemical faecal occult blood test (iFOBT) (National Bowel Cancer Screening Program).
  • Discuss prostate cancer screening, balancing risks and benefits of PSA testing in asymptomatic men.
  • Consider a fasting lipid profile and HbA1c given the family history of cardiovascular disease.
  • Highlight the importance of skin checks given sun exposure.
  • Emphasise shared decision-making, ensuring the patient understands screening tests’ purpose and limitations.

Task 4: Address the patient’s concerns about vaccines or screening tests and provide evidence-based recommendations.

The competent candidate should:

  • Validate concerns and provide clear, factual information about risks and benefits.
  • Reassure that shingles vaccine side effects (e.g., mild fatigue) are short-lived, and severe reactions are rare.
  • Explain that bowel cancer screening is non-invasive, and early detection can prevent cancer progression.
  • Provide written information or refer to trusted sources (e.g., Cancer Council Australia, Immunisation Handbook).

SUMMARY OF A COMPETENT ANSWER

  • Gathers a comprehensive history, including previous vaccinations, screening history, and risk factors.
  • Applies Australian guidelines to recommend age-appropriate vaccinations and screenings.
  • Addresses concerns empathetically, providing clear, evidence-based explanations.
  • Uses shared decision-making to involve the patient in preventive health planning.

PITFALLS

  • Failing to elicit full history of vaccinations and screenings.
  • Recommending unnecessary tests (e.g., routine PSA screening without discussing risks).
  • Not addressing vaccine hesitancy or failing to provide reassuring explanations.
  • Overwhelming the patient with medical jargon instead of patient-friendly language.
  • Not checking for contraindications before recommending vaccines.

REFERENCES

MARKING

Each competency area is assessed on a 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.
1.4 Communicates effectively in routine and difficult situations.

2. Clinical Information Gathering and Interpretation

2.1 Gathers relevant information to determine immunisation and screening eligibility.
2.3 Interprets risk factors for preventive care.

3. Diagnosis, Decision-Making and Reasoning

3.2 Justifies screening recommendations based on guidelines.
3.3 Weighs benefits and risks of vaccination in an elderly patient.

4. Clinical Management and Therapeutic Reasoning

4.1 Provides evidence-based recommendations for immunisation and screening.
4.3 Develops a personalised preventive health plan.

5. Preventive and Population Health

5.1 Applies national guidelines to preventive care.
5.3 Considers patient-specific preventive strategies.

6. Professionalism

6.2 Provides unbiased and evidence-based preventive care.

7. General Practice Systems and Regulatory Requirements

7.1 Adheres to Australian immunisation and screening guidelines.

Competency at Fellowship Level

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