CCE-CE-059.1 - GP Exams

CASE INFORMATION

Case ID: CCE-DERM-019
Case Name: Sarah Whitman
Age: 16
Gender: Female
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: S03 – Warts

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 structured history, including onset, progression, location, and associated symptoms 2.2 Identifies risk factors for persistent or recurrent warts
3. Diagnosis, Decision-Making and Reasoning	3.1 Differentiates between common and less common types of warts 3.2 Identifies when further investigations or referral is required
4. Clinical Management and Therapeutic Reasoning	4.1 Provides evidence-based treatment options, including cryotherapy, topical agents, and watchful waiting 4.2 Educates the patient on self-care and prevention strategies
5. Preventive and Population Health	5.1 Identifies risk factors for transmission and recurrence 5.2 Advises on hygiene and lifestyle measures to reduce spread
6. Professionalism	6.1 Demonstrates empathy and a patient-centred approach
7. General Practice Systems and Regulatory Requirements	7.1 Ensures appropriate documentation and follow-up if treatment is initiated
8. Procedural Skills	8.1 Performs cryotherapy where indicated and educates on post-treatment care
9. Managing Uncertainty	9.1 Recognises when a wart may be atypical and require biopsy or referral
10. Identifying and Managing the Patient with Significant Illness	10.1 Differentiates warts from other dermatological conditions, including skin malignancies

CASE FEATURES

Need for appropriate treatment, education, and reassurance
Multiple plantar warts causing discomfort when walking
Concern about spread and cosmetic appearance
Tried over-the-counter treatments with limited success

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, including wart duration, previous treatments, symptoms, and impact on daily life.
Differentiate between common, plantar, and other types of warts, identifying any red flags for referral.
Provide a diagnosis and discuss an initial management plan.
Educate the patient on treatment options, self-care, prevention, and expected treatment duration.

SCENARIO

Sarah Whitman, a 16-year-old high school student, presents with painful warts on the sole of her foot for the past six months. She is self-conscious about their appearance, especially during PE classes and social activities. She has tried salicylic acid patches from the pharmacy, but they haven’t worked well.

She is worried about the warts spreading and asks if they will ever go away on their own.

Her main concerns are:

“Why won’t the warts go away?”
“Can they spread to other parts of my body?”
“What’s the best way to get rid of them quickly?”
“Will I always have them?”

PATIENT RECORD SUMMARY

Patient Details

Name: Sarah Whitman
Age: 16
Gender: Female
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

None known

Medications

Nil regular medications

Past History

No known immune suppression
Generally well, no chronic medical conditions

Social History

Year 10 high school student
Plays netball, uses communal changing rooms at school and sports centre
Concerned about appearance, especially during PE and social events

Family History

No significant dermatological conditions in family

Vaccination and Preventative Activities

Up to date with all vaccinations, including HPV vaccine

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 have these warts on my foot, and they just won’t go away. I’ve tried the pharmacy stuff, but nothing seems to work.”

General Information

Sarah Whitman is a 16-year-old high school student presenting with multiple plantar warts on her left foot that have been present for six months.

First noticed a small rough spot on the sole of her foot that has since grown larger and spread to two more areas.
Initially painless, but now causes discomfort when walking, especially in tight shoes.
Embarrassed about the appearance, particularly in PE class and at netball practice.
Has tried pharmacy-bought salicylic acid patches for two months but finds them slow and not very effective.

Her main concerns are:

“Why won’t the warts go away?”
“Can they spread to other parts of my body?”
“What’s the best way to get rid of them quickly?”
“Will I always have them?”

Specific Information (To be revealed only when asked)

Symptoms and Impact on Daily Life

The warts are mainly on the ball of the left foot and heel.
Feels a sharp pain when stepping on hard surfaces or when playing netball.
Avoids walking barefoot in public places due to fear of spreading the infection.
Feels self-conscious in the school changing rooms, trying to hide her feet from others.
No warts on the hands, face, or genital area.

Previous Treatments and Outcomes

Tried salicylic acid patches but hasn’t been using them consistently because they take too long.
Has not tried duct tape or home freezing kits.
No previous treatments by a doctor.

Risk Factors and Exposures

Plays netball and regularly uses communal changing rooms.
Often walks around barefoot at home.
No history of immune problems, generally healthy.
Received the HPV vaccine at school.

Concerns About Treatment and Prognosis

Wants the fastest and most effective treatment.
Worried about warts spreading to her hands or face.
Anxious about whether treatment will be painful (concerned about freezing treatment).
Wants to know if warts can come back after removal.

Emotional Cues

Sarah is frustrated and self-conscious but open to treatment suggestions.

Embarrassed about appearance: “It’s really annoying, especially when I have to take my shoes off in front of people.”
Frustrated with ineffective treatments: “I’ve been using the patches, but they take forever, and the wart is still there.”
Worried about future outbreaks: “Will I keep getting these, or will they go away for good?”

If the candidate provides a structured explanation and clear treatment options, Sarah will be reassured and willing to proceed with a treatment plan.

If the candidate is dismissive or vague, she may become more frustrated and hesitant to try further treatments.

Questions for the Candidate

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

“Why won’t my warts go away on their own?”
“Can they spread to my hands or face?”
“What’s the fastest way to get rid of them?”
“Will it be painful if you freeze them?”
“Is there anything I can do to stop them from coming back?”
“Do I need to stay away from netball or school until they go away?”

Expected Reactions Based on Candidate Performance

If the candidate provides a clear explanation and structured plan:

Sarah will feel reassured and willing to try the recommended treatment.
She may say, “I’ll give the freezing a go if it works faster than the patches.”
She will be more confident about prevention strategies and less anxious about recurrence.

If the candidate is vague or dismissive:

Sarah may doubt the effectiveness of treatments and hesitate to continue.
She may say, “So, I just have to wait and hope they go away?”
She may push for unnecessary aggressive treatments.

Key Takeaways for the Candidate

Take a structured wart history, identifying symptom duration, treatments tried, and impact on daily life.
Differentiate plantar warts from other dermatological conditions (e.g., corns, calluses, molluscum contagiosum).
Provide clear treatment options, including:
- Cryotherapy (liquid nitrogen).
- Topical salicylic acid application (consistent use is key).
- Watchful waiting (most warts resolve within two years).
Educate on prevention, including hygiene, avoiding barefoot exposure in public places, and monitoring for recurrence.
Address expectations, explaining that warts may take weeks to months to resolve with treatment.
Ensure follow-up if treatment is initiated, particularly after cryotherapy.

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take an appropriate history, including wart duration, previous treatments, symptoms, and impact on daily life.

The competent candidate should:

Elicit a structured history of warts, including:
- Duration (six months).
- Progression (initially small, now larger and spreading).
- Associated symptoms (pain, discomfort when walking).
- Previous treatments (salicylic acid patches, inconsistent use, minimal response).
Assess impact on daily life, including:
- Self-consciousness during social activities and PE classes.
- Avoidance of walking barefoot in communal areas.
Identify risk factors for recurrence, such as:
- Use of communal changing rooms.
- Barefoot exposure in public areas.
- History of immune suppression (none in this case).

Task 2: Differentiate between common, plantar, and other types of warts, identifying any red flags for referral.

The competent candidate should:

Differentiate plantar warts from other dermatological conditions:
- Plantar warts – Hard, rough lesions on weight-bearing areas, may have black dots (thrombosed capillaries).
- Corns or calluses – Similar in appearance but lack pinpoint bleeding when pared down.
- Molluscum contagiosum – Pearly, umbilicated lesions, commonly seen in children.
Recognise red flags that may require referral:
- Atypical appearance or rapid growth (concern for malignancy).
- Persistent or worsening despite appropriate treatment.
- Signs of secondary infection (pain, pus, spreading redness).

Task 3: Provide a diagnosis and discuss an initial management plan.

The competent candidate should:

Explain the diagnosis:
- Plantar warts caused by human papillomavirus (HPV).
- Not dangerous but may take months to resolve.
Discuss treatment options:
- Cryotherapy (liquid nitrogen) for faster resolution, but may be painful.
- Continued salicylic acid application, ensuring consistent use.
- Watchful waiting (warts often resolve spontaneously in 1–2 years, but this may not be acceptable to the patient).
Address pain relief and symptom management:
- Cushioning insoles to reduce discomfort.
- Soaking and gentle filing to remove dead skin before treatment application.

Task 4: Educate the patient on treatment options, self-care, prevention, and expected treatment duration.

The competent candidate should:

Set expectations for treatment duration:
- Warts may take weeks to months to clear with treatment.
- Multiple sessions of cryotherapy may be required.
Discuss prevention strategies:
- Avoid walking barefoot in public areas.
- Do not pick at warts to prevent spread.
- Ensure good foot hygiene.
Provide safety-netting advice:
- Seek review if warts persist despite treatment, become painful, or show signs of infection.
- Return for follow-up after cryotherapy if required.

SUMMARY OF A COMPETENT ANSWER

Takes a structured wart history, including duration, progression, symptoms, and impact on daily life.
Differentiates plantar warts from other dermatological conditions.
Recognises red flags requiring further investigation or referral.
Provides a structured treatment plan, including cryotherapy, topical treatment, and prevention strategies.
Educates the patient on expected treatment duration, self-care, and recurrence prevention.

PITFALLS

Failing to differentiate warts from other skin conditions, such as corns or molluscum contagiosum.
Not explaining the slow resolution of warts, leading to unrealistic expectations.
Overlooking prevention strategies, increasing the risk of recurrence.
Not addressing the patient’s cosmetic and social concerns, reducing adherence to treatment.
Failing to provide follow-up advice, leading to poor treatment monitoring.

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 structured history, including onset, progression, location, and associated symptoms.
2.2 Identifies risk factors for persistent or recurrent warts.

3. Diagnosis, Decision-Making and Reasoning

3.1 Differentiates between common and less common types of warts.
3.2 Identifies when further investigations or referral is required.

4. Clinical Management and Therapeutic Reasoning

4.1 Provides evidence-based treatment options, including cryotherapy, topical agents, and watchful waiting.
4.2 Educates the patient on self-care and prevention strategies.

5. Preventive and Population Health

5.1 Identifies risk factors for transmission and recurrence.
5.2 Advises on hygiene and lifestyle measures to reduce spread.

6. Professionalism

6.1 Demonstrates empathy and a patient-centred approach.

7. General Practice Systems and Regulatory Requirements

7.1 Ensures appropriate documentation and follow-up if treatment is initiated.

8. Procedural Skills

8.1 Performs cryotherapy where indicated and educates on post-treatment care.

9. Managing Uncertainty

9.1 Recognises when a wart may be atypical and require biopsy or referral.

10. Identifying and Managing the Patient with Significant Illness

10.1 Differentiates warts from other dermatological conditions, including skin malignancies.

Competency at Fellowship Level

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