THE COMPETENT CANDIDATE

The competent candidate should be able to:

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Task 1: Take a focused history, including symptom onset, recent travel, potential exposures, and risk factors.

The competent candidate should:

• Clarify symptom onset and progression:
  • Fever, night sweats, fatigue, muscle aches lasting 10 days.
  • Symptoms worsening at night, waking up drenched in sweat.
• Assess associated symptoms:
  • No cough, sore throat, shortness of breath, chest pain.
  • No weight loss, rashes, or unusual bruising/bleeding.
  • No neurological symptoms (e.g., confusion, headache, neck stiffness).
• Explore recent travel and exposures:
  • Recent trip to Indonesia (rural areas, three weeks ago).
  • No malaria prophylaxis, multiple mosquito bites.
  • Ate street food and drank local tap water.
  • Brief episode of mild diarrhoea while travelling, now resolved.
  • No known sick contacts, but locals seemed unwell.
• Identify risk factors for serious infections:
  • No known immunosuppression, HIV risk factors, or recent hospitalisations.
  • Not up to date on travel vaccinations.
• Address patient concerns and expectations:
  • Fear of malaria, dengue fever, or another serious infection.
  • Concern about spreading illness to family/workmates.
  • Wants blood tests and a clear management plan.

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Task 2: Identify key clinical features and order appropriate investigations to determine the underlying infection.

The competent candidate should:

• Recognise possible infectious causes:
  • Malaria: Travel history, fever pattern, night sweats, mosquito exposure.
  • Dengue fever: Fever, muscle aches, recent tropical travel.
  • Typhoid fever: Fever, fatigue, gastrointestinal exposure history.
  • Other possibilities: Leptospirosis, rickettsial infections, viral hepatitis, tuberculosis.
• Differentiate from other conditions:
  • Haematological malignancies (e.g., lymphoma).
  • Autoimmune conditions (e.g., vasculitis, systemic lupus erythematosus).
• Order appropriate investigations:
  • Full blood count (FBC) and inflammatory markers (CRP, ESR).
  • Malaria thick and thin films, rapid diagnostic test.
  • Dengue serology and NS1 antigen.
  • Liver function tests (LFTs) and renal function.
  • Blood cultures, urine microscopy and culture.
  • Serology for leptospirosis, typhoid, rickettsial infections if indicated.

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Task 3: Explain the likely diagnosis, management options, and need for follow-up.

The competent candidate should:

• Explain likely differentials based on history:
  • Malaria and dengue fever are high on the list.
  • Typhoid or leptospirosis possible given exposure history.
• Discuss initial management:
  • Admit to hospital if malaria is suspected.
  • Ensure hydration and symptomatic management (paracetamol for fever, rest, fluids).
  • Avoid NSAIDs if dengue is suspected due to bleeding risk.
• Outline follow-up plan:
  • Review test results within 24-48 hours.
  • Monitor for worsening symptoms (persistent fever, severe headache, confusion, breathlessness).
  • Refer to infectious diseases specialist if uncertain diagnosis or complex case.

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Task 4: Develop a safe, evidence-based management plan, including supportive care, medications, and public health considerations if relevant.

The competent candidate should:

• Immediate management:
  • Supportive care: Fluids, fever control, rest.
  • Avoid NSAIDs if dengue fever is suspected.
• Antibiotics or antivirals if indicated:
  • Empirical treatment for typhoid if clinically suspected.
  • Malaria treatment guided by species identification.
• Public health and preventive measures:
  • Malaria: Prevent mosquito bites, use repellents, sleep under nets.
  • Dengue: Community mosquito control, avoid aspirin/NSAIDs.
  • Discuss need for travel vaccinations before future trips.
• Referral and follow-up:
  • Hospital admission if unwell or severe symptoms.
  • Infectious diseases review if diagnosis remains unclear.

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SUMMARY OF A COMPETENT ANSWER

• Takes a thorough history, identifying key risk factors (travel, exposures, symptoms).
• Orders targeted investigations to differentiate between malaria, dengue, typhoid, and other infections.
• Provides a clear and reassuring explanation, addressing patient concerns.
• Develops a structured management plan, including symptomatic care, blood tests, and specialist referral if needed.
• Considers public health implications, including disease notification and infection prevention.

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PITFALLS

• Failing to assess travel history thoroughly, missing key risk factors.
• Not considering malaria or dengue fever, leading to delayed diagnosis.
• Overlooking the need for urgent investigations, delaying appropriate treatment.
• Prescribing NSAIDs when dengue fever is possible, increasing bleeding risk.
• Not providing clear patient education, leaving the patient anxious or misinformed.

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REFERENCES

• RACGP – RACGP Guidelines for Infectious Disease Management
• GP Exams – Infectious disease NOS

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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 symptom onset, exposure history, and risk factors.

3. Diagnosis, Decision-Making and Reasoning

3.1 Recognises clinical features suggestive of systemic infection and differentiates from non-infectious causes.

4. Clinical Management and Therapeutic Reasoning

4.1 Develops an evidence-based management plan, including investigations and treatment.

5. Preventive and Population Health

5.1 Provides education on infection prevention, vaccination, and public health measures.

6. Professionalism

6.1 Demonstrates patient-centred care and acknowledges the impact of infection on daily life.

7. General Practice Systems and Regulatory Requirements

7.1 Ensures appropriate documentation and notification of communicable diseases if required.

8. Procedural Skills

8.1 Performs relevant physical examination and orders appropriate tests (e.g., blood cultures, PCR tests).

9. Managing Uncertainty

9.1 Recognises when symptoms require further observation or specialist input.

10. Identifying and Managing the Patient with Significant Illness

10.1 Identifies cases requiring urgent intervention, such as sepsis or meningococcal disease.

Competency at Fellowship Level

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