CCE-CE-005.1

Case ID: 0034
Case Name: Michael Thomas
Age: 25 years
Gender: Male
Indigenous Status: Aboriginal and Torres Strait Islander (ATSI)
Year: 2025
ICPC-2 Codes: T90 (Diabetes non-insulin dependent), T99 (Endocrine/metabolic disease other), A44 (Preventive immunisation/medication)

COMPETENCY OUTCOMES

Competency DomainCompetency Element
1. Communication and Consultation Skills1.1 Communicates effectively and respectfully in a culturally appropriate manner.
1.3 Addresses patient concerns with empathy and clarity.
1.4 Engages the patient in shared decision-making regarding diabetes management.
2. Clinical Information Gathering and Interpretation2.1 Elicits a thorough history, including symptoms, risk factors, and family history.
2.3 Interprets diagnostic results and differentiates between types of diabetes (T2DM vs MODY vs LADA).
3. Diagnosis, Decision-Making and Reasoning3.1 Determines the most likely diagnosis based on clinical findings and investigations.
3.3 Recognises when additional testing (e.g., C-peptide, GAD antibodies) is required.
4. Clinical Management and Therapeutic Reasoning4.1 Develops an individualised treatment plan, considering lifestyle, medications, and cultural factors.
4.3 Provides structured education on diabetes self-management and lifestyle modification.
5. Preventive and Population Health5.1 Addresses risk factors and complications of diabetes in an Aboriginal and Torres Strait Islander context.
5.2 Engages in culturally appropriate health promotion strategies.
6. Professionalism6.2 Ensures culturally safe care that respects the patient’s perspectives and experiences.
7. General Practice Systems and Regulatory Requirements7.1 Engages with Aboriginal Medical Services and other culturally appropriate healthcare pathways.
9. Managing Uncertainty9.1 Recognises uncertainty in diagnosing atypical diabetes (MODY, LADA) and manages appropriately.
10. Identifying and Managing the Patient with Significant Illness10.1 Identifies complications and risk factors requiring early intervention.
11. Aboriginal Health Context (AH)AH1.1 Demonstrates understanding of diabetes prevalence and impact in Aboriginal and Torres Strait Islander communities.
AH1.3 Provides holistic care in collaboration with culturally safe services.

CASE FEATURES

  • Cultural considerations in health beliefs, compliance, and engagement.
  • 25-year-old Aboriginal man with newly diagnosed diabetes following abnormal blood tests.
  • Overweight (BMI 32) and has a family history of diabetes.
  • Presents without classic symptoms but had routine screening due to family history.
  • Diagnostic uncertainty – T2DM, MODY (Maturity-Onset Diabetes of the Young), or LADA (Latent Autoimmune Diabetes in Adults)?
  • Concerns about medication and lifestyle changes.

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. Explain the possible diagnosis
  3. Develop a culturally appropriate management plan
  4. Address concerns about compliance and diabetes education

SCENARIO

Michael Thomas is a 25-year-old Aboriginal man who has come to discuss recent abnormal blood tests. He was tested because of his strong family history of diabetes but does not have thirst, polyuria, or weight loss.

His HbA1c is 7.4%, fasting glucose is 8.1 mmol/L, and repeat glucose is elevated. His BMI is 32, and he has mild hypertension (BP 140/88).

PATIENT RECORD SUMMARY

Patient Details

Name: Michael Thomas
Age: 25 years
Gender: Male
Indigenous Status: Aboriginal

Allergies and Adverse Reactions

  • Nil known

Medications

  • Nil regular medications

Past History

  • Borderline hypertension

Social History

  • Works as a truck driver, often eats takeaways due to long hours.
  • Lives with extended family, including his mother and younger siblings.
  • Smokes 5 cigarettes per day, drinks alcohol socially on weekends.
  • Limited physical activity.

Family History

  • No history of autoimmune conditions.
  • Mother, uncle, and grandmother all have diabetes.

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

“The nurse said I have diabetes, but I don’t get it—I feel fine.”

General Information

  • You are Michael Thomas, a 25-year-old Aboriginal man.
  • You were told that your blood tests show diabetes, but you don’t have any symptoms.
  • You are shocked and confused because you thought only older people got diabetes.
  • You work as a truck driver, often eating takeaways because of long shifts.
  • You live with your extended family, including your mother and younger siblings.
  • You smoke about five cigarettes a day and drink socially on weekends.
  • You have seen family members struggle with diabetes complications, which worries you.

Specific Information (Only Reveal When Asked)

Symptoms and Health History

  • You feel completely fine—no thirst, increased urination, or weight loss.
  • You had routine blood tests because of your family history.
  • The doctor tells you that your HbA1c is 7.4%, which means diabetes.
  • You don’t take any regular medications.

Concerns About the Diagnosis

  • You don’t understand how you can have diabetes without symptoms.
  • You thought only older people got diabetes—this diagnosis doesn’t make sense.
  • You don’t want to take medication yet—you prefer to try diet and exercise first.
  • You worry about ending up like your uncle, who had an amputation from diabetes.
  • You feel nervous about changing your diet because your family eats a lot of fried food.

Barriers to Managing Diabetes

  • Your job as a truck driver makes it hard to eat healthy or exercise regularly.
  • You live with family members who don’t have diabetes, so cooking separate meals feels inconvenient.
  • You don’t want people to think you’re sick.
  • You worry about diabetes affecting your ability to work.

Family and Cultural Considerations

  • You grew up in a tight-knit Aboriginal community and often eat shared family meals.
  • You’ve heard mixed messages about diabetes—some people say it’s not a big deal, while others say it’s a lifelong disease.
  • You are not sure if diabetes is reversible and wonder if losing weight will cure it.

Emotional and Behavioural Cues

  • At first, you are sceptical—you want to know if this diagnosis is real.
  • You avoid eye contact at first, but if the doctor is warm and respectful, you engage more.
  • If the doctor pushes medication without listening to your concerns, you become defensive.
  • If the doctor explains things well, you start asking more questions.
  • If the doctor shows cultural understanding, you become more willing to listen.

Questions You Might Ask

  1. “Are you sure I have diabetes? I don’t feel sick.”
  2. “Is this the same diabetes my mum has?”
  3. “If I lose weight, will it go away?”
  4. “Do I have to take medication for life?”
  5. “How do I manage diabetes when I’m always on the road?”
  6. “What happens if I don’t do anything about it?”
  7. “What foods can I eat? Do I have to give up everything I like?”

How You Might Respond to Different Approaches

If the Doctor Listens and Explains Clearly

  • You engage more in the conversation and start asking more questions.
  • If the doctor says, “I want to work with you to find a plan that fits your lifestyle,” you feel more comfortable.
  • You become more open to discussing small, realistic lifestyle changes.

If the Doctor Pushes Medication Too Soon

  • You feel pressured and defensive.
  • You might say, “I don’t want to take anything. I want to try fixing it myself first.”
  • If the doctor insists, you might shut down the conversation.

If the Doctor Dismisses Your Concerns

  • You feel frustrated and might avoid follow-up appointments.
  • If the doctor says, “You have to take this seriously or you’ll get complications,” you feel talked down to.
  • You might say, “My uncle had diabetes, and he took his tablets, but he still lost his foot—so how do I know this will help?”

Final Thoughts & Decision-Making

  • If the doctor respects your concerns and explains things well, you agree to follow up.
  • If the doctor pushes too hard, you might leave feeling frustrated and unsure.
  • If the doctor suggests culturally appropriate support, like Aboriginal Health Workers, you consider giving it a go.
  • If the doctor acknowledges your work challenges, you appreciate the effort and consider small lifestyle changes.

Summary of Key Role-Player Behaviours

  • Sceptical at first, but engages if treated with respect.
  • Prefers lifestyle changes first, resistant to medication initially.
  • Worried about long-term complications but doesn’t fully understand them.
  • Cultural and social factors impact health choices (family meals, work routine).
  • Needs practical, realistic advice, not just generic health recommendations.

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take an appropriate history, including symptoms, risk factors, and differential diagnosis considerations.

The competent candidate should:

  • Elicit a thorough history, focusing on:
    • Symptoms of diabetes (polyuria, polydipsia, weight loss, fatigue, infections).
    • Any family history of diabetes, autoimmune conditions, or early-onset diabetes.
    • Lifestyle factors (diet, physical activity, smoking, alcohol use, work schedule).
  • Identify risk factors for Type 2 Diabetes Mellitus (T2DM):
    • Overweight (BMI 32), strong family history, and Aboriginal heritage.
  • Assess for possible alternative diagnoses:
    • Maturity-Onset Diabetes of the Young (MODY): Strong family history, mild hyperglycaemia.
    • Latent Autoimmune Diabetes in Adults (LADA): Diabetes without metabolic syndrome, possible autoimmunity.

Task 2: Explain the possible diabetes diagnoses (T2DM vs MODY vs LADA) and the need for further testing.

The competent candidate should:

  • Explain Type 2 Diabetes (T2DM):
    • Most common form, linked to insulin resistance.
    • Often associated with obesity, lifestyle factors, and family history.
  • Explain Maturity-Onset Diabetes of the Young (MODY):
    • A genetic form of diabetes, usually before 25 years of age.
    • Often misdiagnosed as Type 1 or Type 2.
    • Key Features:
      • Early-onset diabetes (usually before 25 years old, but can be diagnosed later in some cases).
      • Strong family history of diabetes in multiple generations (autosomal dominant inheritance).
      • Non-insulin dependent diabetes—many MODY subtypes do not require insulin at diagnosis.
      • Absence of autoimmunity—negative GAD, IA-2, and ZnT8 antibodies (to exclude Type 1 diabetes).
      • Normal or mildly reduced insulin production—C-peptide levels are often normal or slightly low.
      • Lack of significant insulin resistance—often not associated with obesity or metabolic
  • Explain Latent Autoimmune Diabetes in Adults (LADA):
    • A slowly progressive autoimmune diabetes, similar to Type 1.
    • Requires antibody testing (GAD, IA2) and C-peptide.
  • Explain why further tests are needed:
    • HbA1c and fasting glucose confirm persistent hyperglycaemia.
    • Autoimmune markers (GAD, IA2) to exclude LADA.
    • C-peptide levels to assess endogenous insulin production.
    • Genetic testing if MODY is suspected.

Task 3: Develop a culturally appropriate management plan, considering lifestyle, medication, and follow-up.

The competent candidate should:

  • Acknowledge Michael’s concerns and focus on education and engagement.
  • Emphasise lifestyle modification:
    • Dietary changes—realistic adjustments, considering traditional foods and family meals.
    • Physical activity advice, incorporating culturally relevant exercise options.
  • Address his concerns about medication:
    • If Type 2 Diabetes is confirmed, discuss metformin as first-line therapy.
    • If MODY is suspected, sulfonylureas may be appropriate.
    • If LADA, insulin may be required.
  • Refer to culturally safe diabetes support:
    • Aboriginal Health Worker, dietitian, diabetes educator.
    • Community programs such as Deadly Choices or AMS services.
  • Plan for follow-up:
    • Review in 2-4 weeks to assess progress and test results.

Task 4: Address concerns about compliance and diabetes education, incorporating Aboriginal health perspectives.

The competent candidate should:

  • Acknowledge cultural and social factors affecting diabetes management.
  • Use storytelling or yarning to explain diabetes in a relatable way.
  • Discuss barriers (e.g., food choices, work demands, stigma) and provide practical solutions.
  • Encourage self-management skills, including blood glucose monitoring and goal setting.
  • Reassure Michael that diabetes is manageable and that small, sustainable changes can make a difference.

SUMMARY OF A COMPETENT ANSWER

  • Takes a detailed history, including risk factors, symptoms, and family history.
  • Explains the different types of diabetes (T2DM, MODY, LADA) in simple, culturally appropriate language.
  • Outlines further investigations and the importance of accurate diagnosis.
  • Develops an individualised management plan, considering lifestyle, medication, and cultural factors.
  • Addresses concerns about compliance and provides practical, culturally relevant education.

PITFALLS

  • Failing to consider alternative diagnoses (e.g., misdiagnosing LADA as Type 2).
  • Using medical jargon instead of clear, culturally appropriate explanations.
  • Not addressing lifestyle challenges, such as truck driving, family meals, and stigma.
  • Pushing medication without first engaging in shared decision-making.
  • Ignoring the role of Aboriginal Health Workers and culturally safe services.

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 Communicates effectively and respectfully in a culturally appropriate manner.
1.3 Engages the patient in shared decision-making about diabetes management.

2. Clinical Information Gathering and Interpretation

2.1 Elicits a thorough history of symptoms, risk factors, and family history.
2.3 Differentiates between T2DM, MODY, and LADA using appropriate investigations.

3. Diagnosis, Decision-Making and Reasoning

3.1 Determines the most likely diagnosis based on clinical findings and test results.

4. Clinical Management and Therapeutic Reasoning

4.1 Develops a personalised diabetes management plan.
4.3 Provides culturally appropriate education and lifestyle advice.

5. Preventive and Population Health

5.1 Addresses diabetes risk factors in an Aboriginal and Torres Strait Islander context.

6. Professionalism

6.2 Ensures culturally safe and respectful care.

7. General Practice Systems and Regulatory Requirements

7.1 Engages with Aboriginal Medical Services and culturally appropriate healthcare pathways.

9. Managing Uncertainty

9.1 Recognises and responds to uncertainty in diagnosing atypical diabetes presentations.

10. Identifying and Managing the Patient with Significant Illness

10.1 Identifies diabetes complications requiring early intervention.

11. Aboriginal Health Context (AH)

AH1.1 Demonstrates understanding of diabetes prevalence and impact in Aboriginal and Torres Strait Islander communities.
AH1.3 Provides holistic care in collaboration with culturally safe services.

Competency at Fellowship Level

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