THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take a structured history of the patient’s symptoms, duration, and associated risk factors.

The competent candidate should:

• Establish rapport and acknowledge the patient’s frustration regarding their voice loss and work concerns.
• Take a structured respiratory history, including:
  • Symptom onset, duration, and progression (acute vs chronic, worsening trends).
  • Voice symptoms: hoarseness severity, voice fatigue, voice use pattern.
  • Associated symptoms: cough (dry/productive), sore throat, difficulty swallowing, fever, breathing issues.
  • Exacerbating and relieving factors: talking, whispering, hydration, throat clearing, environmental factors.
  • Risk factors: occupational voice strain, exposure to allergens/irritants, recent infections.
• Screen for red flags:
  • Stridor or respiratory distress (suggestive of airway compromise).
  • Dysphagia or weight loss (possible malignancy or neurological causes).
  • Persistent hoarseness >3 weeks (concern for vocal cord pathology).

Task 2: Explain the likely diagnosis and when further investigations or referral are needed.

The competent candidate should:

• Explain the diagnosis in simple terms:
  • The symptoms are consistent with acute laryngitis, most likely viral or strain-related due to excessive voice use.
  • The inflammation of the vocal cords causes hoarseness and irritation.
• Differentiate between common causes:
  • Viral laryngitis (most likely, self-limiting in 1-2 weeks).
  • Vocal strain (common in teachers and frequent voice users).
  • Laryngopharyngeal reflux (LPR) (if associated with reflux symptoms, throat clearing).
  • Less likely causes: bacterial infection (rare), vocal cord nodules, neurological disorders.
• Explain when further investigations or specialist referral is required:
  • Persistent symptoms >3 weeks → ENT referral for laryngoscopy.
  • Stridor, breathing difficulty → urgent assessment for airway compromise.
  • Suspicion of reflux or chronic irritation → trial reflux management before referral.

Task 3: Outline your management plan, including symptomatic relief and voice care strategies.

The competent candidate should:

• Reassure the patient that most cases resolve within 1-2 weeks with supportive care.
• Recommend voice care strategies:
  • Voice rest: minimise speaking, avoid whispering (which strains the vocal cords).
  • Hydration: drink plenty of fluids, use steam inhalation.
  • Avoid irritants: smoking, caffeine, alcohol, excessive throat clearing.
  • Humidified air to ease throat irritation.
• Pharmacological options if needed:
  • Paracetamol or ibuprofen for throat discomfort.
  • Saline gargles, lozenges, or honey for symptomatic relief.
  • Consider PPI trial if reflux symptoms present.
  • No role for antibiotics unless secondary bacterial infection suspected.
• Plan follow-up:
  • If symptoms persist beyond 3 weeks, discuss ENT referral.
  • Reassess if symptoms worsen or new red flags develop.

Task 4: Address the patient’s concerns, particularly regarding work, recovery time, and possible complications.

The competent candidate should:

• Acknowledge the impact on work and offer practical solutions:
  • Encourage short-term voice modifications (using a microphone, written communication).
  • Discuss reasonable adjustments at work.
• Set realistic expectations for recovery:
  • Most cases resolve in 7–14 days, but rest is essential.
  • Overuse may prolong symptoms or cause secondary complications (nodules, chronic laryngitis).
• Reassure regarding complications:
  • This is not permanent, but ongoing strain can lead to long-term vocal cord issues.
  • If symptoms persist, an ENT assessment will rule out structural problems.
• Encourage follow-up to monitor recovery.

SUMMARY OF A COMPETENT ANSWER

• Takes a thorough history, assessing onset, voice use, and red flags.
• Explains the diagnosis clearly, differentiating viral, strain-related, and other causes.
• Identifies red flags requiring ENT referral, including persistent hoarseness >3 weeks or airway symptoms.
• Develops a structured management plan, including voice rest, hydration, and symptom relief.
• Addresses work concerns empathetically, offering realistic recovery expectations and workplace modifications.

PITFALLS

• Failing to assess for red flags, such as stridor, persistent hoarseness, or dysphagia.
• Overprescribing medications, such as antibiotics, without clear indication.
• Not discussing voice care strategies, leading to prolonged recovery.
• Providing false reassurance without follow-up, missing cases requiring ENT referral.
• Neglecting occupational factors, failing to consider work-related voice strain in teachers.

REFERENCES

• RACGP – RACGP Guidelines on Acute Laryngitis Management
• GP Exams – Laryngitis/tracheitis, acute

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

Competency Areas Assessed

1. Communication and Consultation Skills

1.1 Communication is appropriate to the person and the sociocultural context.
1.2 Uses appropriate questioning techniques to explore symptoms and concerns.
1.5 Provides clear explanations about diagnosis and management.

2. Clinical Information Gathering and Interpretation

2.1 Takes a structured respiratory history.
2.2 Identifies red flags requiring urgent intervention.

3. Diagnosis, Decision-Making and Reasoning

3.1 Differentiates between viral and bacterial causes.
3.3 Recognises indications for further investigations or escalation.

4. Clinical Management and Therapeutic Reasoning

4.2 Develops a safe and evidence-based management plan.
4.4 Balances conservative and pharmacological treatment approaches.

5. Preventive and Population Health

5.3 Provides education on voice care, infection prevention, and when to seek further care.

6. Professionalism

6.2 Manages patient expectations and ensures appropriate follow-up.

7. General Practice Systems and Regulatory Requirements

7.1 Ensures appropriate documentation and communication of treatment plans.

9. Managing Uncertainty

9.2 Recognises when specialist referral is required (e.g., ENT for persistent hoarseness).

10. Identifying and Managing the Patient with Significant Illness

10.1 Identifies features of airway compromise requiring urgent intervention.

Competency at Fellowship Level

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