CASE INFORMATION

Case ID:
Case Name: Jack Reynolds
Age: 35
Gender: Male
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: H70 – Otitis Externa

COMPETENCY OUTCOMES

Competency Domain	Competency Element
1. Communication and Consultation Skills	1.1 Engages the patient to gather relevant information about symptoms and concerns 1.2 Provides clear and empathetic explanations regarding the diagnosis and management
2. Clinical Information Gathering and Interpretation	2.1 Takes a comprehensive history, including risk factors for otitis externa 2.2 Performs and interprets relevant clinical assessments to confirm the diagnosis and exclude differential diagnoses
3. Diagnosis, Decision-Making and Reasoning	3.1 Identifies clinical features of otitis externa and differentiates it from otitis media and other causes of ear pain 3.2 Recognises red flags such as severe infection, fever, and spreading erythema requiring urgent management
4. Clinical Management and Therapeutic Reasoning	4.1 Develops an evidence-based management plan, including topical and systemic treatment options 4.2 Advises on pain relief, ear hygiene, and prevention strategies
5. Preventive and Population Health	5.1 Provides advice on preventing recurrent infections, including ear hygiene and swimming precautions
6. Professionalism	6.1 Demonstrates patient-centred care and addresses the impact of symptoms on daily life
7. General Practice Systems and Regulatory Requirements	7.1 Ensures appropriate follow-up and referral if symptoms persist or worsen
8. Procedural Skills	8.1 Demonstrates appropriate ear examination techniques, including otoscopy
9. Managing Uncertainty	9.1 Recognises when symptoms require further investigation, including referral for suspected malignant otitis externa
10. Identifying and Managing the Patient with Significant Illness	10.1 Identifies complications such as cellulitis or perichondritis that require escalation of care

CASE FEATURES

Middle-aged male presenting with ear pain, itching, and discharge, suggestive of otitis externa.
Frequent swimmer, increasing risk of swimmer’s ear.
No recent upper respiratory tract infection, reducing the likelihood of otitis media.
Moderate pain and tenderness, worsened by touching the external ear.
Mild otorrhoea (clear to yellowish discharge) but no fever or systemic symptoms.
Needs advice on treatment options, pain relief, and prevention strategies.

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

Jack Reynolds, a 35-year-old recreational swimmer, presents with a painful and itchy right ear for the past five days. He describes a gradual onset of discomfort, which worsens when he touches or pulls on his ear. He also reports some clear to yellowish discharge but denies hearing loss, fever, or dizziness.

He has been swimming frequently, especially in public pools, and remembers getting water in his ear after his last session. He has tried cotton buds to remove the moisture, but this seemed to make it worse. He has never had ear infections before but occasionally experiences mild hay fever.

PATIENT RECORD SUMMARY

Patient Details

Name: Jack Reynolds
Age: 35
Gender: Male
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

Nil known

Medications

Nil regular medications

Past History

Mild seasonal hay fever
No history of ear infections or hearing loss

Social History

Works in IT, frequently wears earbuds for work calls and music.

Family History

No significant history of ear disease or skin conditions.

Smoking

Non-smoker

Alcohol

Drinks socially on weekends

Vaccination and Preventative Activities

Up to date with routine 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.

ROLE-PLAYER SCRIPT

Opening Line

“Doctor, my right ear has been hurting and itching for a few days now, and it’s getting worse. I think it started after swimming.”

General Information

You are Jack Reynolds, a 35-year-old IT professional who swims regularly in public pools. About five days ago, you started noticing mild itchiness in your right ear. Initially, you didn’t think much of it, but after a couple of days, the itchiness turned into pain.

The pain is now constant and quite sharp, and it gets worse when you touch or pull on your ear. You also feel like your ear is blocked, and there has been some clear to yellowish discharge coming out. You haven’t had any fever, dizziness, or hearing loss, but your ear feels full, and sounds seem slightly muffled on that side.

Specific Information

(Reveal only when asked)

Background Information

You usually dry your ears with cotton buds after swimming, but this time, it seemed to make things worse. You’re frustrated because the discomfort is affecting your sleep, and you are worried about how long this will last.

You have never had ear infections before, and you want to know if you need antibiotics or ear drops to clear it up. You’re also concerned about whether you can continue swimming, as it is an important part of your routine.

Symptoms

The itching started first, followed by pain and mild swelling in the past few days.
The pain is worse when you pull on your ear or press on the tragus.
You have no ringing in your ears (tinnitus) and no vertigo.
You feel like your ear is blocked, but you can still hear.
There has been some clear to yellowish discharge, but no bad smell from the ear.

Past Medical History & Risk Factors

No history of ear infections or ear surgery.
You have mild seasonal hay fever, but it hasn’t been an issue lately.
You have no chronic conditions like diabetes or immune problems.
You frequently swim in public pools and often feel water trapped in your ears.
You regularly use cotton buds to clean your ears.
You wear earbuds often for work calls and music.

Concerns and Expectations

You are worried this could turn into a serious infection.
You are concerned about how long it will take to go away.
You want to know if this will keep happening every time you swim.
You wonder if antibiotics will help or if you need a different treatment.
You are hoping to continue swimming and want to know if it’s safe to do so.

Emotional Cues & Body Language

You seem uncomfortable, tilting your head slightly as if trying to relieve the pressure.
You grimace slightly when describing the pain, especially when mentioning how it worsens when touching your ear.
You appear frustrated when discussing how the cotton buds made it worse.
You look concerned when asking if this could be a serious infection.
If the candidate reassures you and provides a clear plan, you relax and seem more engaged.
If the candidate is vague or dismissive, you become frustrated and push for more details.

Questions for the Candidate (Ask Naturally During the Consultation)

“Is this an infection? Do I need antibiotics?”
“Why does it hurt more when I touch my ear?”
“How long will this take to go away?”
“Can I keep swimming, or do I need to stop?”
“What can I do to prevent this from happening again?”
“Should I be worried about this spreading or getting worse?”

Response to Advice Given by the Candidate

If the candidate explains otitis externa clearly, you feel reassured.
If they suggest ear drops, you ask how long they will take to work and if they will sting.
If they recommend avoiding swimming, you express disappointment but accept it if necessary.
If prevention strategies are explained well, you are interested and engaged and ask if ear plugs could help.
If the candidate fails to provide clear guidance, you push for more details.

Final Thought

If the candidate explains the condition well, provides a clear treatment plan, and addresses your concerns, you feel reassured and ready to follow their advice. If they are vague or dismissive, you remain uncertain and dissatisfied with the consultation.

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take a focused history, including symptom onset, risk factors, and associated symptoms.

The competent candidate should:

Establish rapport and acknowledge the patient’s discomfort and frustration.
Obtain a detailed history of symptoms, including:
- Onset and duration (e.g., five days ago, started with itching).
- Pain characteristics (sharp, worse with touching or pulling the ear).
- Associated symptoms (discharge, hearing changes, dizziness, fever).
- Impact on daily life (sleep, work, swimming).
Identify risk factors, including:
- Swimming habits (public pools, frequency, ear exposure).
- Ear cleaning habits (cotton buds, earplugs, earbuds).
- History of allergies or previous ear infections.
Address patient concerns: duration, treatment options, need for antibiotics, and swimming restrictions.

Task 2: Differentiate between otitis externa and other causes of ear pain.

The competent candidate should:

Recognise key clinical features of otitis externa:
- Ear pain worsening with tragal pressure or pinna movement.
- Itching and mild otorrhoea (clear or yellowish discharge).
- Normal middle ear on otoscopy (no fluid behind the tympanic membrane).
Differentiate from other causes of ear pain:
- Otitis media: Often associated with upper respiratory infections, middle ear effusion, and deep ear pain.
- Temporomandibular joint (TMJ) dysfunction: No external ear tenderness, pain with jaw movement.
- Referred pain (e.g., dental, sinus, cervical spine issues).
Recognise red flags (severe pain, fever, cranial nerve involvement) and when to refer for suspected malignant otitis externa.

Task 3: Explain the likely diagnosis, underlying cause, and available treatment options.

The competent candidate should:

Explain otitis externa in simple terms: inflammation of the external ear canal, often due to water exposure (swimmer’s ear) or trauma from cotton buds.
Address patient concerns about severity and duration, explaining that it is a localised infection and not a serious condition.
Outline treatment options, including:
- Topical antibiotic ear drops (e.g., ciprofloxacin + hydrocortisone) to reduce infection and inflammation.
- Pain relief (paracetamol or NSAIDs).
- Avoidance of further ear trauma (no cotton buds, no swimming until resolved).
- Ear wick insertion if the canal is swollen.
Explain why oral antibiotics are not needed unless there are complications (e.g., cellulitis, systemic symptoms).

Task 4: Develop a safe, evidence-based management plan, including topical treatment, pain relief, and prevention strategies.

The competent candidate should:

Prescribe topical treatment:
- Ciprofloxacin + hydrocortisone ear drops, 3-4 drops, twice daily for 7 days.
- Consider acetic acid drops for mild cases.
Symptom management:
- Paracetamol or ibuprofen for pain relief.
- Keep the ear dry (avoid swimming and inserting objects).
Prevention strategies:
- Use earplugs for swimming.
- Avoid cotton buds and other ear canal trauma.
- Tilt head and dry ears properly after water exposure.
Follow-up:
- Review in one week if symptoms persist.
- Escalate care if severe pain, fever, or worsening symptoms.

SUMMARY OF A COMPETENT ANSWER

Takes a thorough history, including symptom onset, risk factors, and ear care habits.
Recognises classic features of otitis externa and differentiates it from otitis media and other ear conditions.
Explains the diagnosis and treatment in simple terms, addressing patient concerns.
Provides clear management, including topical antibiotics, pain relief, and avoidance of irritants.
Discusses prevention strategies to reduce recurrence risk.

PITFALLS

Failing to distinguish otitis externa from otitis media, leading to incorrect treatment with oral antibiotics.
Overlooking risk factors, such as swimming or cotton bud use, missing key preventive advice.
Not addressing patient concerns, such as swimming restrictions and pain management.
Ignoring red flags, such as severe pain, cranial nerve involvement, or systemic symptoms, which may indicate malignant otitis externa.
Lack of follow-up plan, missing cases of treatment failure or complications.

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 sociocultural context.
1.2 Engages the patient to gather information about their symptoms, ideas, concerns, and expectations.
1.4 Communicates effectively in routine and difficult situations.

2. Clinical Information Gathering and Interpretation

2.1 Takes a comprehensive history, including risk factors for otitis externa.

3. Diagnosis, Decision-Making and Reasoning

3.1 Identifies clinical features of otitis externa and differentiates it from other causes of ear pain.

4. Clinical Management and Therapeutic Reasoning

4.1 Develops an evidence-based management plan, including topical and systemic treatment options.

5. Preventive and Population Health

5.1 Provides advice on preventing recurrent infections, including ear hygiene and swimming precautions.

6. Professionalism

6.1 Demonstrates patient-centred care and addresses the impact of symptoms on daily life.

7. General Practice Systems and Regulatory Requirements

7.1 Ensures appropriate follow-up and referral if symptoms persist or worsen.

8. Procedural Skills

8.1 Demonstrates appropriate ear examination techniques, including otoscopy.

9. Managing Uncertainty

9.1 Recognises when symptoms require further investigation, including referral for suspected malignant otitis externa.

10. Identifying and Managing the Patient with Significant Illness

10.1 Identifies complications such as cellulitis or perichondritis that require escalation of care.

Competency at Fellowship Level

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