CCE-CE-079 - GP Exams

CASE INFORMATION

Case ID: CCE-GEN-001
Case Name: Daniel Thompson
Age: 37
Gender: Male
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: A98 – Other Reason for Encounter NEC/NOS

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 based on the patient’s needs
2. Clinical Information Gathering and Interpretation	2.1 Takes a structured history to understand the patient’s agenda and underlying concerns 2.2 Identifies potential risk factors that may require medical attention
3. Diagnosis, Decision-Making and Reasoning	3.1 Uses clinical reasoning to determine if further investigation is required 3.2 Recognises when reassurance and lifestyle advice are appropriate interventions
4. Clinical Management and Therapeutic Reasoning	4.1 Develops a tailored management plan based on patient needs 4.2 Provides guidance on health promotion and disease prevention
5. Preventive and Population Health	5.1 Identifies opportunities for health promotion, including routine screenings and lifestyle interventions
6. Professionalism	6.1 Demonstrates empathy and patient-centred care
7. General Practice Systems and Regulatory Requirements	7.1 Documents consultation findings and management decisions appropriately
9. Managing Uncertainty	9.1 Recognises when further assessment or follow-up is required

CASE FEATURES

Opportunity for preventive health screening and risk assessment.
A patient presenting with no specific complaint but requests a general check-up.
Mild anxiety about his health despite no major symptoms.
Concerned about hidden illnesses after a recent friend’s diagnosis.
No history of regular health check-ups.

INSTRUCTIONS

You have 15 minutes to complete the tasks for this case.

You should treat this consultation as if it is face to face.

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

Daniel Thompson, a 37-year-old marketing executive, presents for a general check-up with no specific complaint.

His health history includes:

No significant past medical issues.
No regular GP visits in the past 10 years.
Has not had any routine screenings (e.g., cholesterol, diabetes check, blood pressure check).
No recent vaccinations.

PATIENT RECORD SUMMARY

Patient Details

Name: Daniel Thompson
Age: 37
Gender: Male
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

No known drug allergies

Medications

None regularly

Past History

No chronic medical conditions

Social History

Works in marketing, long sedentary hours
Social alcohol use, no smoking

Family History

Father has hypertension and type 2 diabetes (diagnosed in his 50s).
Mother has high cholesterol but no major health issues.

Preventive Activities

No recent vaccinations (uncertain tetanus and flu vaccine status).

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 feel fine, but I thought I should get a check-up since I haven’t had one in years.”

General Information

Daniel Thompson is a 37-year-old marketing executive who is generally healthy but has not seen a doctor in over a decade. He has no specific complaints but has started thinking about his health after a friend was diagnosed with cancer.

Feels fine but is slightly anxious about hidden illnesses.
Wants to know what he should be doing to stay healthy.

Specific Information

(To be revealed only when asked)

Background Information

Has no history of major illnesses or chronic conditions.
Works long hours in a sedentary office job.
Has not had routine blood tests, vaccinations, or health screenings.

Lifestyle and Risk Factors

(Daniel will describe the following when asked about his lifestyle.)

Diet:
- Eats mostly takeaway and processed foods due to a busy schedule.
- Not many vegetables or home-cooked meals.
- Drinks coffee daily but rarely drinks soft drinks.
Exercise:
- Walks to work but doesn’t do structured exercise.
- Occasionally plays social tennis but is inconsistent.
Sleep and Stress Levels:
- Sleeps 5-6 hours per night, often wakes up tired.
- Feels stressed with work deadlines but manages it with social activities and occasional weekend getaways.
Alcohol and Smoking:
- Drinks alcohol socially, about 5-6 drinks on weekends.
- Never smoked.

Concerns About Health Risks

(Daniel will ask about these if prompted.)

“What are the most important things I should be checking?”
“Am I at risk for heart disease or diabetes?”
“My dad developed high blood pressure and diabetes in his 50s. Does that mean I will too?”
“Should I be worried about cancer?”
“How often should I have check-ups?”

Preventive Health and Medical History

(Daniel will provide this information when prompted.)

No previous serious illnesses or surgeries.
No history of high blood pressure or cholesterol checks.
No recent blood tests.
Not sure if his tetanus or flu vaccinations are up to date.
No history of bowel cancer in the family but unsure about other cancers.

Emotional Cues

Daniel is not overly anxious but wants to be proactive about his health.

If given clear advice and a structured plan, he will be motivated to follow recommendations.
If dismissed or given vague responses, he may feel unsure about the value of health check-ups and disengage.
He is slightly worried about family history but does not want to overreact.

Questions for the Candidate

Daniel may ask some or all of the following:

“What tests do I need?”
“How often should I be seeing a doctor?”
“What can I do to stay healthy long-term?”
“Do I need to worry about my family history?”
“Are there any vaccines I should be getting?”
“Do I need a heart check? I don’t have symptoms, but my dad had high blood pressure.”
“Should I be worried about cancer screening?”

Expected Reactions Based on Candidate Performance

If the candidate provides a clear explanation and structured plan:

Daniel will feel reassured and motivated to improve his health.
He may say: “That makes sense. I’ll book those tests and try to be more active.”
He will ask follow-up questions about implementing lifestyle changes.

If the candidate is vague or dismissive:

Daniel may feel uncertain about the importance of routine check-ups.
He may say: “So, I don’t really need to worry about anything?”
He may feel that the check-up was unnecessary and may not return for future health reviews.

Key Takeaways for the Candidate

Elicit the patient’s agenda and underlying health concerns.
Conduct a targeted history to identify potential risk factors.
Provide a structured health check-up plan, including relevant screenings (BP, cholesterol, diabetes risk, vaccinations).
Offer lifestyle recommendations tailored to the patient’s needs.
Educate on the importance of regular health maintenance.

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take an appropriate history, including the patient’s concerns, lifestyle habits, and relevant medical history.

The competent candidate should:

Explore the patient’s agenda and health concerns:
- “What prompted you to come for a check-up today?”
- “Are there any specific health concerns on your mind?”
Assess lifestyle factors and risk behaviours:
- Dietary habits (high in processed foods, low in vegetables).
- Physical activity levels (sedentary job, irregular exercise).
- Alcohol intake (social drinking on weekends).
- Smoking status (never smoked).
Screen for symptoms of common chronic diseases:
- Cardiovascular risks: shortness of breath, chest pain, palpitations.
- Diabetes risks: excessive thirst, frequent urination, fatigue.
- Mental health: stress levels, sleep quality.
Identify relevant family history:
- Father with hypertension and type 2 diabetes.
- Mother with high cholesterol.
- No family history of bowel cancer.

Task 2: Identify any risk factors that may require further assessment or preventive measures.

The competent candidate should:

Recognise modifiable risk factors:
- Unhealthy diet and sedentary lifestyle increase the risk of cardiovascular disease and diabetes.
- Family history suggests increased risk for metabolic conditions.
Assess need for routine screenings based on age and risk profile:
- Blood pressure measurement.
- Fasting lipid profile.
- Fasting glucose or HbA1c (considering family history of diabetes).
- BMI and waist circumference assessment.
Evaluate vaccination status:
- Influenza vaccine (annually).
- Tetanus booster (if not up to date).
- COVID-19 vaccine (if not fully vaccinated).

Task 3: Provide a tailored health check-up plan, including relevant screening tests and lifestyle advice.

The competent candidate should:

Recommend appropriate preventive health measures:
- Routine blood tests to assess cardiovascular and metabolic risk.
- Blood pressure monitoring for early detection of hypertension.
- Encourage bowel cancer screening (FOBT from age 50 or earlier if risk factors exist).
Provide lifestyle modification advice:
- Encourage a balanced diet (Mediterranean diet, increased vegetables, reduced processed foods).
- Suggest a structured exercise plan (minimum 150 minutes/week of moderate-intensity exercise).
- Discuss sleep hygiene and stress management.
Discuss alcohol intake and safe drinking limits (≤2 standard drinks per day, avoid binge drinking).

Task 4: Address the patient’s health concerns and provide reassurance where appropriate.

The competent candidate should:

Acknowledge the patient’s concerns about hidden illnesses and reassure appropriately.
- “It’s great that you’re thinking about your health early—preventive check-ups can help detect and reduce risks before problems arise.”
Provide structured follow-up advice:
- “I recommend we do some baseline tests today, and we can review the results in a few weeks.”
- “Your risk factors suggest areas we can improve, but there are no immediate red flags.”
Encourage long-term health maintenance and regular check-ups.

SUMMARY OF A COMPETENT ANSWER

Takes a structured history, addressing patient concerns, lifestyle habits, and family history.
Identifies key risk factors, including diet, physical activity, metabolic risk, and family history.
Recommends appropriate preventive screenings, including BP check, lipid profile, fasting glucose, and vaccinations.
Provides tailored lifestyle modification advice, encouraging dietary changes, regular exercise, and alcohol moderation.
Reassures the patient while emphasising the importance of proactive health management.

PITFALLS

Failing to explore the patient’s agenda, missing the underlying concerns behind the check-up.
Overlooking lifestyle and modifiable risk factors, focusing only on current symptoms rather than prevention.
Neglecting appropriate health screenings, such as BP, lipid profile, or diabetes screening.
Providing vague or dismissive reassurance, failing to engage the patient in proactive health management.
Not documenting the discussion appropriately, including risk assessment and recommendations.

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, and expectations.
1.3 Provides clear and structured explanations based on the patient’s needs.

2. Clinical Information Gathering and Interpretation

2.1 Takes a structured history to understand the patient’s agenda and underlying concerns.
2.2 Identifies potential risk factors that may require medical attention.

3. Diagnosis, Decision-Making and Reasoning

3.1 Uses clinical reasoning to determine if further investigation is required.
3.2 Recognises when reassurance and lifestyle advice are appropriate interventions.

4. Clinical Management and Therapeutic Reasoning

4.1 Develops a tailored management plan based on patient needs.
4.2 Provides guidance on health promotion and disease prevention.

5. Preventive and Population Health

5.1 Identifies opportunities for health promotion, including routine screenings and lifestyle interventions.

6. Professionalism

6.1 Demonstrates empathy and patient-centred care.

7. General Practice Systems and Regulatory Requirements

7.1 Documents consultation findings and management decisions appropriately.

9. Managing Uncertainty

9.1 Recognises when further assessment or follow-up is required.

Competency at Fellowship Level

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