THE COMPETENT CANDIDATE

The competent candidate should be able to:

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Task 1: Take an appropriate history, focusing on symptom duration, severity, hydration status, and possible exposures.

The competent candidate should:

• Elicit a detailed symptom history, including:
  • Onset, duration, and progression of symptoms.
  • Frequency and characteristics of diarrhoea (watery, bloody, mucus-containing).
  • Presence of associated symptoms (vomiting, abdominal pain, fever, lightheadedness).
• Assess hydration status:
  • Oral intake vs fluid losses (urine output, dizziness, signs of dehydration).
  • Postural symptoms (dizziness, weakness).
• Explore possible exposures:
  • Recent food intake (takeaway seafood reported).
  • Sick contacts or co-workers with similar symptoms.
  • Travel history (though absent in this case).
• Identify red flags requiring escalation:
  • Severe dehydration (reduced urine output, dry mucous membranes, tachycardia).
  • Bloody diarrhoea, high fever, or neurological symptoms (suggesting invasive bacterial infection).
  • Prolonged symptoms (>7 days) or worsening condition.
• Clarify patient concerns:
  • Work-related absenteeism and when to return safely.
  • Infection risk to housemates and co-workers.
  • Need for antibiotics or further testing.

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Task 2: Formulate a differential diagnosis and justify your reasoning.

The competent candidate should:

• Most likely diagnosis: Acute gastroenteritis, likely foodborne (viral or bacterial).
• Consider alternative causes:
  • Viral gastroenteritis (Norovirus, Rotavirus) – most common, often self-limiting.
  • Bacterial gastroenteritis (Salmonella, Campylobacter, E. coli) – suspected in foodborne outbreaks, persistent symptoms, or bloody diarrhoea.
  • Parasitic infection (Giardia, Cryptosporidium) – if symptoms persist >10 days.
  • Other conditions: Inflammatory bowel disease (IBD), medication-induced diarrhoea, or irritable bowel syndrome (IBS) if chronic symptoms.
• Justify investigations only if clinically indicated:
  • Stool cultures if symptoms are severe, prolonged, or associated with red flags.
  • Blood tests (electrolytes, renal function) if dehydration is a concern.

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Task 3: Develop a management plan, including hydration strategies, medication use, and infection control.

The competent candidate should:

• Reassure the patient that most cases of gastroenteritis are viral and self-limiting within 5-7 days.
• Hydration management:
  • Encourage oral rehydration with electrolyte solutions (e.g., Hydralyte, Gastrolyte).
  • Advise small, frequent sips of fluids (water, clear broths, diluted juices).
  • Avoid caffeinated, sugary, or alcoholic beverages, which can worsen dehydration.
• Symptom relief:
  • Paracetamol for fever or abdominal cramps.
  • Loperamide (only if necessary, and no fever or bloody stools present).
• Discuss antibiotic use:
  • Not routinely recommended unless bacterial infection is strongly suspected (e.g., bloody diarrhoea, prolonged fever).
  • Empirical treatment (e.g., azithromycin) may be considered for suspected bacterial gastroenteritis in severe cases.
• Infection control and return to work:
  • Strict hand hygiene (soap and water, hand sanitisers).
  • Avoid preparing food for others for at least 48 hours post-symptom resolution.
  • Return to work only after 48 hours of being symptom-free.
• Arrange follow-up in 48-72 hours if symptoms persist.

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Task 4: Address the patient’s concerns, particularly regarding symptom severity, work absence, and risk to others.

The competent candidate should:

• Acknowledge the patient’s frustration about missing work and validate concerns.
• Explain the natural course of gastroenteritis, reassuring that most cases resolve within a few days.
• Advise on work absence:
  • Returning too soon increases the risk of spreading infection.
  • Emphasise the importance of staying off work for at least 48 hours post-symptom resolution.
• Provide clear infection control guidance:
  • Strict handwashing, avoiding shared towels and utensils.
  • Disinfecting commonly touched surfaces at home.
• Discuss when to seek further medical attention:
  • Persistent symptoms beyond 7 days.
  • Signs of worsening dehydration (dizziness, reduced urine output).
  • Development of red flag symptoms (bloody diarrhoea, severe pain, high fever).

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SUMMARY OF A COMPETENT ANSWER

• Takes a structured history, assessing hydration status, symptom severity, and exposure risks.
• Formulates a clear differential diagnosis, considering viral vs bacterial gastroenteritis, foodborne illness, and alternative causes.
• Provides evidence-based management, including hydration advice, symptomatic relief, and infection control.
• Educates the patient on antibiotic use, avoiding unnecessary prescriptions.
• Addresses patient concerns empathetically, providing clear return-to-work guidance.
• Recognises when to escalate care, such as in cases of severe dehydration or prolonged symptoms.

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PITFALLS

• Failing to assess dehydration risk, potentially missing moderate to severe dehydration.
• Prescribing antibiotics unnecessarily, contributing to antibiotic resistance and side effects.
• Neglecting to provide infection control advice, increasing the risk of spread to housemates and co-workers.
• Overlooking the need for follow-up, particularly in prolonged or worsening cases.
• Not recognising red flags, such as bloody diarrhoea, severe pain, or signs of systemic infection.
• Giving incorrect return-to-work advice, leading to premature exposure of others to infection.

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REFERENCES

• Royal Children’s Hospital – Gastroenteritis
• GP Exams – Gastroenteritis

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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 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 on their lives.
1.4 Communicates effectively in routine and difficult situations.

2. Clinical Information Gathering and Interpretation

2.1 Gathers a relevant and focused history.
2.2 Identifies red flags and risk factors.

3. Diagnosis, Decision-Making and Reasoning

3.1 Formulates appropriate differential diagnoses.
3.3 Considers common and serious conditions.

4. Clinical Management and Therapeutic Reasoning

4.1 Develops an evidence-based management plan.
4.2 Uses shared decision-making in treatment options.

5. Preventive and Population Health

5.1 Provides education on food hygiene and infection control.
5.3 Discusses vaccination for gastroenteritis prevention (e.g., rotavirus).

6. Professionalism

6.2 Demonstrates a professional and non-judgmental approach.

7. General Practice Systems and Regulatory Requirements

7.2 Understands public health reporting requirements for notifiable gastroenteritis outbreaks.

8. Procedural Skills

8.1 Recognises when stool sample testing is indicated.

9. Managing Uncertainty

9.1 Identifies when referral for hospitalisation is warranted.

10. Identifying and Managing the Patient with Significant Illness

10.1 Recognises dehydration and electrolyte imbalance requiring escalation of care.

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Competency at Fellowship Level

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