CCE-CE-041

THE COMPETENT CANDIDATE

The competent candidate should be able to:

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Task 1: Take an appropriate history, considering the patient’s symptoms, smoking history, and previous COPD management.

The competent candidate should:

• Use open-ended questions to explore symptom progression, including dyspnoea, cough, sputum production, and wheezing.
• Elicit red flag symptoms such as orthopnoea, paroxysmal nocturnal dyspnoea, chest pain, or haemoptysis.
• Clarify exacerbation frequency, previous hospitalisations, and response to treatment.
• Assess medication adherence and potential inhaler technique issues.
• Review smoking history and cessation attempts, including cravings and triggers.
• Explore the impact of COPD on daily activities, sleep, and mental well-being.
• Check vaccination history (influenza, pneumococcal).
• Ask about past pulmonary rehabilitation participation and understanding of the program.

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Task 2: Explain the likely diagnosis and disease progression, addressing the patient’s concerns about worsening symptoms.

The competent candidate should:

• Provide a clear explanation of COPD progression, tailored to the patient’s health literacy.
• Discuss why symptoms have worsened despite smoking cessation—emphasising irreversible airway damage but highlighting benefits of quitting (slower disease progression, reduced exacerbations).
• Address fears about oxygen therapy, explaining that while some COPD patients require it, appropriate management can delay or prevent its necessity.
• Describe common COPD complications, such as respiratory infections, pulmonary hypertension, and muscle deconditioning.
• Use visual aids or metaphors (e.g., “Your airways are like clogged pipes, and medications help open them up”).
• Encourage realistic expectations about treatment, explaining how inhaler optimisation, pulmonary rehab, and vaccines can improve symptoms.

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Task 3: Develop a management plan, including pharmacological and non-pharmacological strategies, and address preventive measures.

The competent candidate should:

• Review current medication use, adjusting if necessary (e.g., optimising LABA/LAMA therapy).
• Assess inhaler technique, providing education and a demonstration if needed.
• Prescribe a COPD action plan for recognising and managing exacerbations.
• Recommend pulmonary rehabilitation for symptom improvement and better exercise tolerance.
• Discuss smoking cessation strategies (NRT, varenicline, counselling).
• Address vaccination gaps (influenza, pneumococcal).
• Encourage graded exercise and physiotherapy for muscle deconditioning.
• Provide safety netting advice, ensuring the patient knows when to seek urgent care.

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Task 4: Provide education on inhaler use and lifestyle modifications, ensuring the patient understands their treatment and long-term management.

The competent candidate should:

• Demonstrate correct inhaler technique using a stepwise approach.
• Check for misuse of short-acting bronchodilators (over-reliance on Ventolin).
• Discuss avoiding environmental triggers, including cold air, pollutants, and infections.
• Encourage weight maintenance, balanced diet, and hydration.
• Explain the role of breathing techniques (pursed-lip breathing).
• Discuss psychosocial support, including anxiety management related to COPD.

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SUMMARY OF A COMPETENT ANSWER

• Uses structured history-taking to assess symptom progression, exacerbations, and lifestyle impact.
• Provides a clear and empathetic explanation of COPD progression and prognosis.
• Tailors a comprehensive management plan, including medication review, vaccinations, pulmonary rehab, and action plans.
• Demonstrates strong patient education skills, including inhaler technique training and smoking cessation counselling.
• Addresses patient concerns directly, reducing anxiety and improving engagement in self-care.

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PITFALLS

• Failure to assess inhaler technique, leading to ineffective medication use.
• Overlooking smoking cessation support, despite the patient’s recent quit attempt.
• Providing an overly negative prognosis, increasing patient anxiety instead of encouraging proactive management.
• Not recommending pulmonary rehabilitation, missing an opportunity to improve exercise tolerance and symptom control.
• Neglecting vaccination history, increasing infection risk.
• Failing to address oxygen therapy concerns, leaving the patient fearful and misinformed.

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REFERENCES

• COPD-X Guidelines
• RACGP – COPD diagnosis, management and the role of the GP
• National Asthma Council – Inhaler Device Use
• Lung Foundation Australia – Pulmonary Rehabilitation
• GP Exams – Chronic Obstructive Pulmonary Disease (COPD)

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MARKING

Each competency area is assessed on the following scale from 0 to 3.

☐ Competency NOT demonstrated
☐ Competency NOT CLEARLY demonstrated
☐ Competency SATISFACTORILY demonstrated
☐ Competency FULLY demonstrated

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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 Conducts a structured, hypothesis-driven history to assess risk factors and disease severity.
☐ 2.2 Identifies clinical features suggestive of exacerbation or complications.

3. Diagnosis, Decision-Making and Reasoning

☐ 3.1 Uses clinical reasoning to establish a working diagnosis of COPD.
☐ 3.2 Differentiates COPD from other causes of dyspnoea, including cardiac conditions.

4. Clinical Management and Therapeutic Reasoning

☐ 4.1 Develops an evidence-based management plan, incorporating pharmacological and non-pharmacological strategies.
☐ 4.2 Prescribes and titrates inhaler therapy appropriately.
☐ 4.3 Educates the patient on the correct use of inhalers.

5. Preventive and Population Health

☐ 5.1 Provides smoking cessation advice and resources.
☐ 5.2 Assesses vaccination status and recommends influenza and pneumococcal vaccines.

6. Professionalism

☐ 6.1 Demonstrates respect, empathy, and cultural sensitivity when discussing prognosis and lifestyle modifications.

7. General Practice Systems and Regulatory Requirements

☐ 7.1 Recognises and follows Medicare guidelines for chronic disease management, including GP Management Plans (GPMP) and Team Care Arrangements (TCA).

8. Procedural Skills

☐ 8.1 Demonstrates correct inhaler technique and peak flow measurement.

9. Managing Uncertainty

☐ 9.1 Recognises potential complications (e.g., respiratory failure) and determines when to escalate care.

10. Identifying and Managing the Patient with Significant Illness

☐ 10.1 Recognises signs of severe COPD exacerbation and initiates appropriate urgent management.

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Competency at Fellowship Level

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