Case ID: ATSI-INF-001
Case Name: Noah Taylor
Age: 6 months
Gender: Male
Indigenous Status: Aboriginal
Year: 2025
ICPC-2 Codes: R78 – Bronchiolitis, A98 – Indigenous Health Issue

COMPETENCY OUTCOMES

Competency Domain	Competency Element
1. Communication and Consultation Skills	1.1 Communicates effectively with the caregiver, addressing concerns empathetically 1.3 Uses culturally safe communication techniques with Aboriginal and Torres Strait Islander families
2. Clinical Information Gathering and Interpretation	2.1 Takes a thorough history, including social and environmental factors impacting health 2.3 Identifies red flags for severe bronchiolitis
3. Diagnosis, Decision-Making and Reasoning	3.1 Recognises clinical features of bronchiolitis and assesses severity
4. Clinical Management and Therapeutic Reasoning	4.2 Provides supportive care and safety-netting advice 4.3 Determines criteria for escalation and transfer to a higher level of care
5. Preventive and Population Health	5.2 Identifies modifiable risk factors such as smoking exposure and overcrowding
6. Professionalism	6.3 Engages with local Aboriginal health workers for culturally safe care
7. General Practice Systems and Regulatory Requirements	7.4 Utilises appropriate Medicare-funded Aboriginal health services (e.g., 715 health check)
9. Managing Uncertainty	9.2 Ensures appropriate follow-up and reassessment plans in a resource-limited setting
10. Identifying and Managing the Patient with Significant Illness	10.1 Recognises when an infant requires urgent intervention or retrieval
11. Aboriginal Health Context (AH)	AH1.2 Considers social determinants of health impacting Aboriginal infants AH1.3 Utilises culturally appropriate resources for education and support
12. Rural Health Context (RH)	RH1.2 Manages acute paediatric illness in a remote setting with limited resources RH1.4 Coordinates care with regional paediatric services for escalation if required

CASE FEATURES

Need for clear safety-netting and culturally appropriate communication
Aboriginal infant in a remote community with bronchiolitis
Concerned parents with limited health literacy
Limited local resources (e.g., no paediatric ICU, reliance on retrieval services)
Risk factors include household smoking, overcrowding, and lack of easy access to healthcare

INSTRUCTIONS

You have 15 minutes to complete the tasks for 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:

Take an appropriate history.
Outline the differential diagnosis and key investigations required.
Address the patient’s concerns.
Develop a safe and patient-centred management plan.

SCENARIO

Noah Taylor, a 6-month-old Aboriginal boy from a remote Northern Territory community, is brought to your clinic by his mother, Sarah, who is worried that he has been struggling to breathe. Sarah explains that Noah has had a runny nose and cough for the past three days, but today, his breathing seems more laboured, and he refuses to feed.

The local Aboriginal health worker has checked Noah’s vital signs and notes mild intercostal recession, a respiratory rate of 58 breaths per minute, and an oxygen saturation of 92% on room air. He has no history of wheezing or asthma.

PATIENT RECORD SUMMARY

Patient Details

Name: Noah Taylor
Age: 6 months
Gender: Male
Gender Assigned at Birth: Male
Indigenous Status: Aboriginal

Allergies and Adverse Reactions

Nil known

Medications

Nil regular

Past History

Preterm birth at 35 weeks
No previous hospitalisations

Social History

Lives with extended family in a remote community

Family History

Older sibling hospitalised for pneumonia last year
No family history of asthma

Smoking

Household smoking exposure

Alcohol

Nil relevant

Vaccination and Preventative Activities

Up to date with immunisations, including RSV monoclonal antibody

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 really worried, Doctor. Noah’s been breathing fast all day, and he won’t drink his bottle.”

General Information

Sarah Taylor is a 24-year-old Aboriginal mother from a remote Northern Territory community. She has three children and relies on local health services for their medical needs. She is deeply concerned about her youngest child, Noah, who is six months old. Over the past few days, she noticed Noah had a runny nose and a slight cough, but last night he started breathing faster. Today, he refuses to feed, which is making her very anxious.

Specific Information

(Only reveal when asked relevant questions)

Background Information

Sarah’s eldest child, now three years old, was hospitalised with a chest infection last year, which was a stressful experience for the family. She fears Noah might also need hospitalisation, but she is worried about how she will manage, given that the nearest paediatric hospital is over 300 km away.

Sarah lives in a crowded home with extended family, including her parents, siblings, and several nieces and nephews. Her father smokes inside the house, which she suspects might not be good for Noah’s health, but she feels powerless to change the situation. She is hesitant to bring this up unless directly asked.

Sarah is unsure about the severity of Noah’s illness and doesn’t want to overreact, but she feels that something is not right. She hopes the doctor can tell her whether she needs to take Noah to the hospital or if she can care for him at home.

Symptoms and Timeline

Day 1 (Two days ago): Noah developed a mild runny nose and a slight cough. He was still feeding well and behaving normally.
Day 2 (Yesterday): His cough worsened slightly, and he seemed more tired than usual. He had a normal number of wet nappies but was fussier with feeds.
Day 3 (Today): Noah has been breathing faster, and she has noticed a sucking-in motion under his ribs. He has refused to drink for most of the day and has only had two wet nappies in the last 12 hours. He seems weaker and is more irritable than usual.

Breathing Concerns

Noah’s breathing is noticeably faster than usual.
There are times when his chest seems to suck in under his ribs when he breathes.
His breathing sounds noisier at times, but she isn’t sure if it is wheezing.
She hasn’t noticed any blue colour around his lips, but his skin looks slightly pale.

Feeding and Hydration

Noah usually breastfeeds every 3-4 hours, but today he has refused most feeds.
He has only had a few small sips in the last six hours.
Usually, he has five or six wet nappies a day, but today he has only had two.

Home Environment and Social Factors

Sarah lives with her parents, siblings, and extended family in a crowded household.
Her father smokes inside, but she doesn’t feel comfortable asking him to stop.
The family has limited access to medical care, and they rely on the local clinic for most health issues.
There is no easy transport to the nearest hospital. If Noah needs to go, she is unsure how she will get there.

Understanding of the Condition and Concerns

She thinks Noah might have a bad cold, but she doesn’t know if it’s serious.
She is worried about dehydration since Noah isn’t drinking.
She is scared that this might be the same illness that led to her eldest child’s hospitalisation.
She doesn’t know whether he needs antibiotics or other treatment.
She is afraid of being away from home for too long if she has to go to the hospital.

Emotional Cues

(Role-player should respond with appropriate emotions)

Anxious and worried: Sarah frequently asks whether Noah is seriously ill.
Guilt and helplessness: If asked about household smoking, she may appear uncomfortable or upset.
Stressed about transport: She expresses concern about how she would get to the hospital.
Reassured if given a clear plan: If the candidate explains the illness and what to watch for, she will feel slightly relieved but may still seek reassurance.

Questions for the Candidate

(Ask these naturally during the conversation)

“Does he need to go to the hospital? I don’t know how I’ll get there.”
“Is this as serious as what my daughter had last year?”
“Is there anything I can do at home to help him breathe better?”
“Will he need medicine for this? Should he be on antibiotics?”
“How can I stop him from getting sick like this again?”
“Is there something in the house that could be making him worse?”

Expectations

(What Sarah wants from the consultation)

Clear advice on whether Noah needs to be hospitalised.
Practical guidance on how to manage his symptoms at home if safe to do so.
Reassurance that she is making the right decision for her child.
Non-judgmental support regarding household smoking and other social challenges.
Education on how to prevent future respiratory illnesses.

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take a focused history from the caregiver, ensuring a culturally safe approach.

The competent candidate should:

Use open-ended questions to explore Noah’s symptoms, including onset, duration, progression, and severity.
Assess feeding and hydration status, including number of wet nappies and level of alertness.
Elicit risk factors such as household smoking, overcrowding, and recent illnesses in the home.
Demonstrate cultural awareness and sensitivity, engaging with the mother in a respectful, non-judgemental manner.
Address the caregiver’s ideas, concerns, and expectations (ICE), including fears about hospitalisation and transport issues.

Task 2: Assess the severity of the infant’s illness and determine if escalation is required.

The competent candidate should:

Recognise red flags for severe bronchiolitis, including respiratory distress (increased work of breathing, nasal flaring, intercostal recession), lethargy, poor feeding, and reduced urine output.
Interpret vital signs appropriately (respiratory rate of 58/min, oxygen saturation of 92%).
Classify bronchiolitis severity based on Australian guidelines.
Identify that mild cases may be managed at home with supportive care, while moderate to severe cases may require hospitalisation.
Consider logistical challenges in a rural setting, including the need for early retrieval planning if deterioration is likely.

Task 3: Explain your diagnosis and management plan to the caregiver using clear, understandable language.

The competent candidate should:

Use simple, jargon-free language to explain bronchiolitis as a viral infection affecting the lungs.
Clarify that antibiotics are not required and that management is primarily supportive.
Provide safety-netting advice, ensuring Sarah understands when to return urgently (increased work of breathing, worsening feeding, reduced alertness).
Explain home management strategies, including saline nasal drops, small frequent feeds, and keeping Noah upright.
Discuss the possibility of hospitalisation, addressing Sarah’s concerns about transport and logistics.

Task 4: Provide culturally appropriate advice on prevention and follow-up care.

The competent candidate should:

Educate on reducing smoke exposure, using a non-judgemental approach.
Discuss RSV immunoprophylaxis if available for high-risk infants.
Provide information on hand hygiene and infection control in crowded households.
Offer follow-up options, including review at the local clinic and engagement with Aboriginal health workers for support.

SUMMARY OF A COMPETENT ANSWER

Elicits a thorough history, including symptom progression, hydration status, and social risk factors.
Recognises severity indicators and applies Australian guidelines for bronchiolitis assessment.
Provides a structured, clear explanation of the diagnosis, management, and safety-netting advice.
Uses culturally safe communication, addressing caregiver concerns empathetically.
Considers rural and logistical challenges, ensuring appropriate escalation planning.

PITFALLS

Failure to elicit key risk factors, such as household smoking or overcrowding.
Not recognising red flags for severe bronchiolitis (e.g., worsening respiratory distress, dehydration).
Over-reliance on medical jargon, making explanations difficult for the caregiver to understand.
Lack of clear safety-netting advice, missing an opportunity to educate the caregiver on warning signs.
Ignoring the cultural context, leading to disengagement or reduced adherence to recommendations.
Not considering rural limitations, such as transport difficulties and access to tertiary care.

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 Communication is appropriate to the person and the sociocultural context.
1.3 Uses culturally safe communication techniques with Aboriginal and Torres Strait Islander families.

2. Clinical Information Gathering and Interpretation

2.1 Takes a thorough history, including social and environmental factors impacting health.
2.3 Identifies red flags for severe bronchiolitis.

3. Diagnosis, Decision-Making and Reasoning

3.1 Recognises clinical features of bronchiolitis and assesses severity.

4. Clinical Management and Therapeutic Reasoning

4.2 Provides supportive care and safety-netting advice.
4.3 Determines criteria for escalation and transfer to a higher level of care.

5. Preventive and Population Health

5.2 Identifies modifiable risk factors such as smoking exposure and overcrowding.

6. Professionalism

6.3 Engages with local Aboriginal health workers for culturally safe care.

7. General Practice Systems and Regulatory Requirements

7.4 Utilises appropriate Medicare-funded Aboriginal health services (e.g., 715 health check).

9. Managing Uncertainty

9.2 Ensures appropriate follow-up and reassessment plans in a resource-limited setting.

10. Identifying and Managing the Patient with Significant Illness

10.1 Recognises when an infant requires urgent intervention or retrieval.

11. Aboriginal Health Context (AH)

AH1.2 Considers social determinants of health impacting Aboriginal infants.
AH1.3 Utilises culturally appropriate resources for education and support.

12. Rural Health Context (RH)

RH1.2 Manages acute paediatric illness in a remote setting with limited resources.
RH1.4 Coordinates care with regional paediatric services for escalation if required.

Competency at Fellowship Level

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