CCE-CE-084 - GP Exams

CASE INFORMATION

Case ID: CCE-DERM-002
Case Name: Emily Carter
Age: 19
Gender: Female
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: S97 – Acne

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 explanations about acne and management options
2. Clinical Information Gathering and Interpretation	2.1 Takes a thorough dermatological, medical, and lifestyle history 2.2 Identifies acne severity and potential underlying causes
3. Diagnosis, Decision-Making and Reasoning	3.1 Differentiates between types of acne (comedonal, inflammatory, nodulocystic) and identifies complications (scarring, post-inflammatory hyperpigmentation)
4. Clinical Management and Therapeutic Reasoning	4.1 Provides an appropriate stepwise treatment plan 4.2 Discusses topical and oral treatment options, including isotretinoin if indicated
5. Preventive and Population Health	5.1 Provides education on skincare, lifestyle modifications, and acne triggers
6. Professionalism	6.1 Provides patient-centred, non-judgmental care
7. General Practice Systems and Regulatory Requirements	7.1 Documents acne severity, treatment plan, and potential need for dermatology referral
9. Managing Uncertainty	9.1 Addresses patient concerns about acne persistence and treatment efficacy
10. Identifying and Managing the Patient with Significant Illness	10.1 Recognises and refers severe or treatment-resistant acne appropriately

CASE FEATURES

Asks about oral medication, including isotretinoin.
19-year-old university student presents with persistent acne on face and back.
Concerned about scarring and self-esteem.
Tried over-the-counter treatments with no success.
No significant medical history but recently started oral contraceptives.

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

Emily Carter, a 19-year-old university student, presents with persistent acne on her face and back. She has tried multiple over-the-counter treatments with little improvement.

Her dermatological history includes:

Acne started at age 16, worsened in the last year.
Current breakout consists of inflammatory papules and pustules with some nodules on the jawline and back.
Tried over-the-counter benzoyl peroxide, salicylic acid, and tea tree oil without success.

PATIENT RECORD SUMMARY

Patient Details

Name: Emily Carter
Age: 19
Gender: Female
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

No known drug allergies

Medications

Combined oral contraceptive (COC) – started 3 months ago

Past History

No significant medical conditions.
No history of isotretinoin use.

Social History

University student, high stress levels.

Preventive Activities

No regular dermatology follow-ups.

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 like my skin is ruining my life. I’ve tried everything, and nothing works. What can I do?”

General Information

Emily Carter is a 19-year-old university student struggling with persistent acne on her face and back. She has tried multiple over-the-counter treatments, but her skin continues to break out, making her feel self-conscious and frustrated. She wears heavy makeup daily to cover the acne and worries about permanent scarring.

She is open to treatment options but hesitant about oral medications, particularly isotretinoin. She has heard mixed things online and is unsure about what actually works.

She feels that acne is affecting her confidence and social life, especially since her friends don’t seem to struggle with their skin.

Specific Information

(To be revealed only when asked)

Acne Symptoms

(Emily will describe these details if prompted.)

Started getting acne at 16, but it has worsened over the past year.
Breakouts mainly on the face (cheeks, chin, jawline) and upper back.
Mostly inflamed papules and pustules, some nodules, but no deep cysts.
Mild tenderness in some areas but no severe pain.

Skincare Routine

(Emily will share this information if asked.)

Washes her face twice a day with a foaming cleanser.
Uses benzoyl peroxide and tea tree oil daily.
Does not use moisturiser because she thinks it will make her skin oily.
Uses an oil-based foundation to cover acne.
Sometimes sleeps with makeup on, especially after late nights studying.

Medical and Lifestyle History

(Emily will discuss these if prompted.)

Started a combined oral contraceptive (COC) three months ago.
No known hormonal issues (no PCOS diagnosis, regular periods).
No history of isotretinoin use.
No food allergies or intolerances.
No known medication allergies.

Diet and Lifestyle

(Emily will provide these details if asked.)

Eats a typical student diet—some processed foods, occasional fast food, but also home-cooked meals.
Drinks a lot of coffee and energy drinks.
Does not drink much water.
Exercises regularly but does not always shower or wash her face immediately after sweating.
Feels stressed about university workload and social life.

Emotional Cues and Responses

Emily is feeling frustrated, self-conscious, and slightly desperate for a solution. She wants to hear a clear plan but is also worried about long-term effects and medication side effects.

If the candidate is empathetic and provides a structured plan, she will feel reassured and motivated.
If the candidate dismisses her concerns or rushes through the consultation, she may feel hopeless and less likely to follow treatment.
If the candidate jumps straight to isotretinoin without explaining other options, she may resist and express concerns about side effects.

She wants realistic advice and a plan that fits into her lifestyle.

Questions for the Candidate

Emily may ask some or all of the following:

“How long will this take to clear up?”
“Do I need to stop wearing makeup?”
“I’ve been on the pill for three months—shouldn’t my acne be better by now?”
“What about those skincare products influencers talk about? Are they any good?”
“Isotretinoin sounds dangerous—do I really need it?”
“Do I need to change my diet? People say dairy and sugar cause acne.”
“Will this ever go away, or will I have acne forever?”

Expected Reactions Based on Candidate Performance

If the candidate provides a clear, step-by-step plan:

Emily will feel reassured and more willing to follow a treatment plan.
She will ask more about specific treatments and how to incorporate them into her routine.
She may accept the idea of prescription medications if explained properly.

If the candidate is vague or dismissive:

Emily may become more anxious and hopeless about her acne.
She might be reluctant to try medical treatments and continue relying on ineffective over-the-counter products.
She may not follow up or adhere to recommendations.

Key Role-Playing Behaviour Based on Candidate Approach

If the candidate takes a supportive, patient-centred approach:

Emily will feel validated and motivated to improve her skincare and follow treatment recommendations.
She will engage in discussions about lifestyle, skincare routine, and realistic treatment expectations.
She will be more willing to consider prescription treatments, even isotretinoin, if presented as a last-resort option.

If the candidate is too directive or judgmental:

Emily may shut down and become defensive.
She may reject certain treatments out of fear.
She may continue harmful skincare habits (e.g., over-washing, using harsh products).

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take an appropriate history, including acne severity, skincare routine, triggers, and medical background.

The competent candidate should:

Elicit details about acne symptoms, including:
- Duration, progression, and severity.
- Types of lesions (comedonal, inflammatory, nodulocystic).
- Presence of scarring or post-inflammatory hyperpigmentation.
- Pain, tenderness, or psychological distress.
Assess skincare routine and lifestyle factors, including:
- Frequency and method of face washing.
- Use of topical products (cleansers, benzoyl peroxide, retinoids).
- Makeup use and removal practices.
- Dietary patterns (dairy, high glycaemic index foods, supplements).
Identify potential underlying causes and risk factors, including:
- Family history of acne.
- Hormonal influences (menstrual cycle, PCOS symptoms).
- Medications (steroids, oral contraceptives, lithium).
- Stress and sleep patterns.

Task 2: Assess and explain the likely type and severity of acne and discuss potential complications.

The competent candidate should:

Classify acne severity based on lesion type and distribution:
- Mild – Comedonal acne (blackheads, whiteheads).
- Moderate – Papules and pustules, some nodules.
- Severe – Nodulocystic acne with risk of scarring.
Explain acne pathophysiology clearly to the patient:
- Blocked hair follicles, increased sebum production, bacterial overgrowth, inflammation.
- Influence of hormones and genetics.
Discuss potential complications:
- Scarring and post-inflammatory hyperpigmentation.
- Psychosocial impact (low self-esteem, anxiety, depression).
Address misconceptions and provide reassurance:
- Acne is not caused by poor hygiene.
- Certain lifestyle changes can help but are not the sole treatment.

Task 3: Provide a structured treatment plan, including topical and oral therapies, lifestyle advice, and referral indications.

The competent candidate should:

For mild acne:
- Topical retinoids (adapalene, tretinoin) to unclog pores.
- Benzoyl peroxide to reduce inflammation and bacteria.
For moderate acne:
- Add oral antibiotics (doxycycline, minocycline) for inflammatory lesions.
- Consider combined oral contraceptive pill if hormonal component suspected.
For severe or nodulocystic acne:
- Refer to a dermatologist for consideration of isotretinoin.
Lifestyle and skincare advice:
- Use a gentle, non-comedogenic cleanser twice daily.
- Avoid scrubbing or over-washing.
- Remove makeup before bed and use oil-free products.
- Discuss potential triggers (high GI diet, stress).
- Encourage sun protection to prevent post-inflammatory pigmentation.

Task 4: Address the patient’s concerns about scarring, long-term treatment, and isotretinoin use.

The competent candidate should:

Explain that early treatment can prevent scarring and pigmentation issues.
Discuss treatment duration and realistic expectations (improvement takes weeks to months).
Address fears about isotretinoin:
- Highly effective but reserved for severe cases.
- Potential side effects (dry skin, mood changes, teratogenicity).
- Strict monitoring and pregnancy prevention requirements.

SUMMARY OF A COMPETENT ANSWER

Takes a thorough history of acne severity, skincare routine, and lifestyle factors.
Classifies acne type and explains pathophysiology clearly.
Provides a structured stepwise treatment plan, including topical and systemic options.
Addresses patient concerns about scarring, long-term management, and isotretinoin.
Offers realistic expectations and reassurance about treatment efficacy.

PITFALLS

Failing to assess hormonal influences, medication history, and lifestyle factors.
Not differentiating between mild, moderate, and severe acne.
Overlooking the psychosocial impact of acne.
Jumping to isotretinoin without considering first-line treatments.
Providing vague or dismissive advice without addressing patient concerns.

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 a clear and structured explanation of acne management.

2. Clinical Information Gathering and Interpretation

2.1 Takes a thorough dermatological, medical, and lifestyle history.
2.2 Identifies acne severity and potential underlying causes.

3. Diagnosis, Decision-Making and Reasoning

3.1 Differentiates between mild, moderate, and severe acne.
3.2 Identifies complications such as scarring or psychosocial impact.

4. Clinical Management and Therapeutic Reasoning

4.1 Provides an appropriate stepwise treatment plan.
4.2 Discusses topical, oral, and specialist referral options.

5. Preventive and Population Health

5.1 Provides education on skincare, lifestyle modifications, and acne triggers.

6. Professionalism

6.1 Provides patient-centred, non-judgmental care.

7. General Practice Systems and Regulatory Requirements

7.1 Documents acne severity, treatment plan, and potential need for dermatology referral.

9. Managing Uncertainty

9.1 Addresses patient concerns about acne persistence and treatment efficacy.

10. Identifying and Managing the Patient with Significant Illness

10.1 Recognises and refers severe or treatment-resistant acne appropriately.

Competency at Fellowship Level

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