CCE-CE-051 - GP Exams

CASE INFORMATION

Case ID: CCE-DS-011
Case Name: Michael Thompson
Age: 28
Gender: Male
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: S29 – Skin symptom/complaint, other

COMPETENCY OUTCOMES

Competency Domain	Competency Element
1. Communication and Consultation Skills	1.1 Establishes rapport and engages the patient 1.2 Explores the patient’s concerns, ideas, and expectations 1.3 Provides clear and structured explanations about diagnosis, prognosis, and management
2. Clinical Information Gathering and Interpretation	2.1 Takes a focused dermatological history, including onset, duration, progression, triggers, and associated symptoms 2.2 Identifies red flags and risk factors for serious skin conditions
3. Diagnosis, Decision-Making and Reasoning	3.1 Differentiates between common skin conditions (e.g., eczema, fungal infections, psoriasis, allergic reactions) 3.2 Identifies when further investigations or specialist referral is required
4. Clinical Management and Therapeutic Reasoning	4.1 Provides evidence-based management options, including medical and lifestyle interventions 4.2 Educates the patient on skin care, triggers, and symptom control
5. Preventive and Population Health	5.1 Provides education on skin protection and risk factor modification 5.2 Encourages regular skin checks, especially for individuals at risk of skin cancer
6. Professionalism	6.1 Demonstrates empathy and a patient-centred approach to managing chronic skin conditions
7. General Practice Systems and Regulatory Requirements	7.1 Ensures appropriate follow-up and referrals to dermatology if indicated
8. Procedural Skills	8.1 Orders and interprets relevant investigations (e.g., skin scrapings, blood tests) if required
9. Managing Uncertainty	9.1 Recognises when symptoms may indicate an underlying systemic condition (e.g., autoimmune disease, drug reaction)
10. Identifying and Managing the Patient with Significant Illness	10.1 Identifies and appropriately manages dermatological conditions that may impact quality of life (e.g., chronic eczema, severe acne, skin infections)

CASE FEATURES

Potential need for investigations, medical treatment, and lifestyle modifications
Persistent, itchy skin rash affecting daily life
Concern about whether the condition is contagious or serious
Impact on work and social interactions due to appearance and discomfort

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

Michael Thompson, a 28-year-old office worker, presents with a persistent, itchy rash on his arms and neck that has been present for four weeks. He describes the rash as red, slightly raised, and occasionally flaky, with intense itching at night.

He is worried about whether the rash is contagious because some of his colleagues have noticed it and have asked if he is okay. He has not changed his soap, laundry detergent, or skincare products recently.

PATIENT RECORD SUMMARY

Patient Details

Name: Michael Thompson
Age: 28
Gender: Male
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

None known

Medications

Nil regular medications

Past History

No history of eczema, psoriasis, or autoimmune disease
No known skin allergies or past reactions

Social History

Works full-time in an office, no occupational exposure to chemicals

Family History

No family history of eczema, psoriasis, or autoimmune skin conditions

Smoking

Non-smoker

Alcohol

Drinks 2–3 glasses of beer per week

Vaccination and Preventative Activities

Up to date with vaccinations

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.

SCRIPT FOR ROLE-PLAYER

Opening Line

“Doctor, I’ve had this itchy rash on my arms and neck for the past month, and it’s driving me crazy. I don’t know what’s causing it.”

General Information

Michael Thompson is a 28-year-old office worker who presents with a persistent, itchy rash on his arms and neck that has been present for four weeks.

The rash started gradually, initially as mild redness, but has worsened over time.
The rash is red, slightly raised, and flaky in some areas.
The itching is severe, especially at night, and sometimes wakes him up.
He has not had this rash before and is worried about whether it is contagious.

Specific Information

(To be revealed only when asked)

Background Information

He has tried using a moisturiser and changing his soap, but nothing has helped.
His colleagues have noticed it, and he feels embarrassed wearing short sleeves at work.

His main concerns are:

“What is causing this rash? Is it something serious?”
“Could this be an allergy or an infection?”
“How do I stop the itching? It’s keeping me up at night.”
“Do I need any tests or to see a specialist?”

Rash and Skin Symptoms

Rash started four weeks ago and has gradually spread from the arms to the neck and upper chest.
Red, raised patches that are slightly flaky in some areas.
No blisters, pus, or open wounds, but some scratches from itching.
No oozing, fever, or swollen lymph nodes.
Itching is worse at night, making it hard to sleep.
No burning or tingling sensations.

Triggers and Exposures

No new skincare products, soaps, or detergents.
No recent illness or antibiotic use.
No new foods or known food allergies.
No contact with animals or recent outdoor activities.
No recent travel or insect bites.
No contact with anyone who has a rash or skin condition.

Impact on Daily Life

Feels self-conscious about the rash, avoiding short-sleeved shirts at work.
Colleagues have noticed and asked about it, making him uncomfortable.
Itching affects his sleep, leading to daytime tiredness and trouble concentrating at work.
Scratching sometimes makes the rash feel sore.

Medical History and Risk Factors

No history of eczema, psoriasis, or autoimmune conditions.
No personal or family history of skin allergies or atopic conditions.
No past reactions to soaps, fragrances, or metals.
Has never had a similar rash before.

Social History

Works full-time in an office, no exposure to workplace irritants.
Lives with his partner, no one else at home has a rash.
Non-smoker, drinks alcohol occasionally (2–3 beers per week).
No recreational drug use.

Emotional Cues

Michael is worried but open to discussion.

Concerned about the cause: “Is this something contagious?”
Frustrated by the itching: “I can’t stop scratching, and nothing helps.”
Embarrassed about appearance: “People at work keep asking me what’s wrong with my skin.”
Anxious about needing tests: “Will I need a biopsy or blood tests?”

If the candidate provides a clear explanation and structured plan, he will be reassured and engaged.
If the candidate is vague or dismissive, he may become frustrated or push for unnecessary tests.

Questions for the Candidate

Michael will ask some of the following questions, especially if the doctor does not address them directly:

“Do I need blood tests or a skin biopsy?”
“Could this be an allergy or an infection?”
“Should I be worried about something serious, like an autoimmune disease?”
“What treatments can help stop the itching?”
“Do I need to see a dermatologist?”
“Is this going to be permanent?”
“What can I do to prevent this from happening again?”

Expected Reactions Based on Candidate Performance

If the candidate provides a clear explanation and structured plan:

Michael will be reassured and engaged.
He will accept recommendations for treatment and follow-up.
He may say, “That makes sense. I’ll try the treatment and see if it improves.”

If the candidate is vague or dismissive:

Michael may appear frustrated or push for unnecessary tests.
He may say, “Are you sure this isn’t something serious?”

If the candidate does not provide a management plan:

Michael may say, “So, what am I supposed to do now? Just wait and see?”
He may seem unsatisfied and ask for a second opinion.

Key Takeaways for the Candidate

Take a detailed dermatological history, including onset, triggers, and associated symptoms.
Consider possible causes, including eczema, allergic dermatitis, fungal infections, and autoimmune conditions.
Provide an initial management plan, including:
- Topical treatments (e.g., emollients, corticosteroids, antihistamines).
- Lifestyle modifications (avoiding triggers, proper skin care routine).
- Education on when to seek further medical attention.
Arrange follow-up, ensuring monitoring and escalation if symptoms persist.

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take an appropriate history, including onset, triggers, associated symptoms, and impact on daily life.

The competent candidate should:

Elicit a detailed dermatological history, including onset, duration, and progression of the rash.
Assess associated symptoms, such as itching, pain, burning, oozing, or systemic symptoms (fever, weight loss, joint pain).
Explore possible triggers, including new skincare products, soaps, detergents, allergens, or environmental exposures.
Assess past medical history, including eczema, psoriasis, allergic conditions, or autoimmune diseases.
Screen for occupational or lifestyle factors, such as work-related irritants or stress.
Determine impact on daily life, including sleep disturbance, social embarrassment, or workplace concerns.

Task 2: Identify potential underlying causes and recommend appropriate investigations.

The competent candidate should:

Consider differential diagnoses, including:
- Eczema (atopic dermatitis) – chronic, itchy, dry skin with a history of allergies.
- Contact dermatitis – triggered by allergens or irritants (soaps, metals, detergents).
- Fungal infection (tinea corporis) – scaly, red patches with central clearing.
- Psoriasis – thick, well-demarcated plaques, often on extensor surfaces.
- Drug reaction or autoimmune condition (e.g., lupus, dermatomyositis) – systemic symptoms and photosensitivity.
Order relevant investigations if indicated, such as:
- Skin scrapings for fungal microscopy and culture (if fungal infection is suspected).
- Patch testing for contact dermatitis (if allergen-related).
- Blood tests (FBC, ESR, CRP, ANA) if autoimmune disease is suspected.

Task 3: Provide an initial management plan, including symptom relief, lifestyle modifications, and medical treatments where necessary.

The competent candidate should:

Provide general skin care advice, including avoiding irritants, using fragrance-free moisturisers, and maintaining skin hydration.
Initiate symptomatic treatment, such as:
- Topical corticosteroids (mild to moderate potency) for inflammatory skin conditions.
- Oral antihistamines for itching, particularly if disrupting sleep.
- Topical antifungal treatment if a fungal infection is suspected.
Educate on avoiding scratching and recommend cotton clothing and gentle skin care routines.
Provide an action plan for flare-ups and when to seek medical attention.

Task 4: Discuss follow-up and when further assessment or specialist referral may be required.

The competent candidate should:

Arrange follow-up in 2–4 weeks to assess treatment response and modify management if needed.
Refer to a dermatologist if:
- The rash does not respond to initial treatment.
- There is diagnostic uncertainty or suspicion of an autoimmune or systemic condition.
- The patient has recurrent or severe flare-ups affecting quality of life.

SUMMARY OF A COMPETENT ANSWER

Takes a detailed history, assessing onset, triggers, symptoms, and impact on daily life.
Considers and explains differential diagnoses, including eczema, contact dermatitis, fungal infections, and psoriasis.
Orders appropriate investigations, such as skin scrapings, patch testing, or blood tests when needed.
Provides an evidence-based management plan, including topical treatments, antihistamines, and lifestyle advice.
Discusses follow-up and escalation, ensuring ongoing monitoring and referral if necessary.

PITFALLS

Failing to explore full dermatological history, missing key triggers or associated symptoms.
Overlooking systemic symptoms, such as weight loss, fatigue, or joint pain, which may indicate an underlying autoimmune disease.
Prescribing treatment without a clear diagnosis, leading to inappropriate therapy (e.g., steroid use in fungal infections).
Not addressing lifestyle contributors, such as irritants, allergens, or workplace exposures.
Failing to arrange follow-up, leading to poor monitoring of symptoms and treatment effectiveness.

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.
1.2 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.
1.3 Provides clear and structured explanations about diagnosis, prognosis, and management.

2. Clinical Information Gathering and Interpretation

2.1 Takes a focused dermatological history, including onset, duration, progression, triggers, and associated symptoms.
2.2 Identifies red flags and risk factors for serious skin conditions.

3. Diagnosis, Decision-Making and Reasoning

3.1 Differentiates between common skin conditions (e.g., eczema, fungal infections, psoriasis, allergic reactions).
3.2 Identifies when further investigations or specialist referral is required.

4. Clinical Management and Therapeutic Reasoning

4.1 Provides evidence-based management options, including medical and lifestyle interventions.
4.2 Educates the patient on skin care, triggers, and symptom control.

5. Preventive and Population Health

5.1 Provides education on skin protection and risk factor modification.
5.2 Encourages regular skin checks, especially for individuals at risk of skin cancer.

6. Professionalism

6.1 Demonstrates empathy and a patient-centred approach to managing chronic skin conditions.

7. General Practice Systems and Regulatory Requirements

7.1 Ensures appropriate follow-up and referrals to dermatology if indicated.

8. Procedural Skills

8.1 Orders and interprets relevant investigations (e.g., skin scrapings, blood tests) if required.

9. Managing Uncertainty

9.1 Recognises when symptoms may indicate an underlying systemic condition (e.g., autoimmune disease, drug reaction).

10. Identifying and Managing the Patient with Significant Illness

10.1 Identifies and appropriately manages dermatological conditions that may impact quality of life (e.g., chronic eczema, severe acne, skin infections).

Competency at Fellowship Level

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