CASE INFORMATION

Case ID: RFE-001
Case Name: Emily Carter
Age: 42
Gender: Female
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Code: A98 – Reason for Encounter/Demand Not Otherwise Specified

COMPETENCY OUTCOMES

Competency Domain	Competency Element
1. Communication and Consultation Skills	1.1 Engages the patient to understand their concerns and expectations. 1.2 Demonstrates active listening and empathy. 1.4 Explains diagnosis and management in a patient-centred manner.
2. Clinical Information Gathering and Interpretation	2.1 Takes a comprehensive history, including psychosocial factors. 2.2 Identifies underlying concerns contributing to the reason for encounter.
3. Diagnosis, Decision-Making and Reasoning	3.1 Establishes a working diagnosis based on patient concerns and clinical reasoning. 3.2 Recognises when further clarification is required to ensure patient needs are addressed.
4. Clinical Management and Therapeutic Reasoning	4.1 Develops an evidence-based management plan. 4.7 Uses shared decision-making to address concerns.
5. Preventive and Population Health	5.1 Identifies and addresses preventive health opportunities.
6. Professionalism	6.2 Provides reassurance and addresses patient concerns sensitively.
7. General Practice Systems and Regulatory Requirements	7.1 Documents history, discussion, and management plan appropriately.
9. Managing Uncertainty	9.3 Recognises when a vague or unclear reason for encounter requires further clarification.
10. Identifying and Managing the Patient with Significant Illness	10.1 Recognises when an unclear patient request may indicate underlying significant health concerns.

CASE FEATURES

Middle-aged woman presenting with a vague request for a “full check-up.”
No specific symptoms offered initially, requiring clarification.
Possible hidden agenda, such as fear of cancer, recent health scare, or anxiety.
Patient may require reassurance, screening, or further discussion of health concerns.
Requires shared decision-making to align expectations with evidence-based care.

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

Emily Carter, a 42-year-old administrative assistant, presents to your clinic asking for a “full check-up”. When asked for specifics, she responds vaguely, saying she just wants to “make sure everything is okay.”

Her observations today are:

BP: 126/80 mmHg
HR: 72 bpm, regular
Temp: 36.6°C
RR: 14 breaths/min
Oxygen saturation: 99% on room air

PATIENT RECORD SUMMARY

Patient Details

Name: Emily Carter
Age: 42
Gender: Female
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

Nil known

Medications

Nil regular

Past History

No chronic medical conditions
No prior major surgeries

Social History

Occupation: Administrative assistant – sedentary work
Smoking: Never smoked
Alcohol: 2-3 standard drinks per week

Family History

Mother: Hypertension, high cholesterol
Father: Type 2 diabetes

Vaccination and Preventative Activities

Pap smear last done five years ago, no recent mammogram

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 SCRIPTS

Opening Line

“Doctor, I just want a full check-up to make sure everything is okay.”

General Information

You are a 42-year-old administrative assistant and generally feel well.
You haven’t been to a doctor in years and feel like it’s time to get things checked.
You don’t have any specific symptoms, but you sometimes feel a bit tired, which you assume is due to work stress.

Specific Information

(Only Provide If Asked)

Background Information

You have no history of major medical conditions.
You have never smoked, and you drink alcohol only occasionally.
You don’t take any medications regularly.

Concerns and Hidden Agenda

A colleague at work was recently diagnosed with cancer, which has made you anxious about your own health.
You haven’t had any symptoms, but the idea of silent illnesses worries you.
You don’t have a family history of cancer, but you worry about missing something serious.
You are particularly concerned about whether you need tests, scans, or blood work to check for cancer or other hidden conditions.

Preventive Health and Lifestyle

Your last Pap smear was five years ago, and you have never had a mammogram.
You have never had your cholesterol or blood sugar checked.
You are not very physically active, mostly due to long hours sitting at work.
Your diet is okay, but you eat a lot of processed foods and takeaway meals due to a busy schedule.
You haven’t noticed any weight loss or gain, but you feel like your energy levels could be better.

Emotional and Psychological State

You are feeling a little anxious but not overwhelmed.
You don’t want to seem overly worried, but you also don’t want to ignore your health.
You’re looking for reassurance and guidance on what tests are necessary.
You want to know how often you should be coming in for check-ups.
You don’t want to be over-tested, but you also don’t want to miss anything important.

Concerns & Expectations

You want to know if you need blood tests, scans, or other health checks.
You are worried that you may have an undiagnosed health issue.
You are not sure what a “full check-up” includes but want to be proactive.
You are open to lifestyle advice, but you want to know what’s most important to check first.

Possible Questions for the Candidate

“What tests do I actually need?”
“Do I need a full-body scan to make sure there’s nothing wrong?”
“Could I have something serious and not know it?”
“Should I be worried about cancer?”
“How often should I get check-ups?”
“Is there anything I should change about my lifestyle?”
“Would blood tests show if I have something serious?”
“Is it too late to start taking my health seriously?”

How to Respond to the Candidate’s Explanations

If the Candidate Explains That Routine Screening is Based on Age and Risk Factors:

“So, what are the most important tests for me at my age?”
“Does that mean I don’t need a full-body scan?”

If the Candidate Recommends a General Health Check-Up:

“What exactly does that involve?”
“Would that include checking for things like diabetes or high cholesterol?”

If the Candidate Addresses Cancer Screening Specifically:

“What cancers should I be screened for at my age?”
“Would a blood test show if I have cancer?”

If the Candidate Mentions Lifestyle Changes:

“Is it too late to start exercising and eating better?”
“How much of a difference would lifestyle changes make?”

If the Candidate Dismisses Your Concerns Without Explanation:

“But what if I do have something wrong and we miss it?”
“I just want to make sure I’m doing the right things for my health.”

Role-Playing Tips for the Candidate Assessment

You are concerned but not panicked. You want a clear and logical discussion about what tests are necessary.
You are open to advice but also want to feel reassured that nothing is being overlooked.
If the candidate does not ask about your hidden agenda, prompt them by saying, “I suppose I got a bit worried after a colleague was recently diagnosed with cancer.”
If the candidate suggests unnecessary testing, express hesitation. Ask, “Do I really need that, or is it just for peace of mind?”
If the candidate dismisses your concerns too quickly, push back. Ask, “How do you know I don’t need more tests?”
You are willing to make changes to improve your health but need clear, realistic guidance.

Final Line (If the Candidate Handles the Case Well)

“Thanks, Doctor. I feel a lot better knowing what I need to focus on. I’ll book in for those tests, and I’ll try to be more mindful of my health going forward.”

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take a focused history, clarifying the reason for the patient’s visit and any underlying concerns.

The competent candidate should:

Engage the patient with open-ended questions to explore their motivation for the check-up.
Use active listening to identify underlying concerns (e.g., anxiety about health, recent health scares, or screening needs).
Clarify any specific symptoms or risk factors the patient may not have mentioned initially.
Take a comprehensive history, including:
- Family history of chronic diseases (e.g., cancer, diabetes, cardiovascular disease).
- Lifestyle factors (smoking, alcohol, diet, physical activity).
- Mental health and stressors that may be influencing health concerns.
- Preventive health history, including past screenings (Pap smear, mammogram, cholesterol, blood glucose).
Identify any red flags requiring further investigation.
Address patient expectations regarding investigations and follow-up.

Task 2: Identify potential hidden concerns and outline an initial management plan.

The competent candidate should:

Acknowledge the patient’s concerns and validate their feelings.
Recognise that the recent diagnosis of cancer in a colleague may have triggered health anxiety.
Explain that most people in their 40s benefit from targeted health checks rather than unnecessary tests.
Provide individualised recommendations based on risk factors, including:
- Cardiovascular risk screening (blood pressure, lipid profile, fasting glucose).
- Cancer screening (Pap smear, mammogram if due).
- Lifestyle discussion (exercise, diet, alcohol intake).
Discuss whether blood tests are necessary and tailor investigations accordingly.
Provide reassurance and education about evidence-based preventive health care.
Offer a structured follow-up plan, including review of results and ongoing preventive care.

Task 3: Address the patient’s expectations regarding investigations and follow-up.

The competent candidate should:

Clarify misconceptions about “full-body scans” and explain that routine full-body imaging is not evidence-based.
Discuss the role of blood tests, explaining that:
- Routine tests (e.g., FBC, LFTs) are not always needed unless indicated by symptoms or risk factors.
- Targeted tests (e.g., cholesterol, glucose) may be appropriate based on lifestyle and family history.
Balance reassurance with appropriate investigation, ensuring the patient feels heard.
Encourage ongoing GP visits for preventive health rather than one-off check-ups.
Provide clear instructions for follow-up, including timelines for any tests and review.

Task 4: Develop a comprehensive management plan, including preventive health discussions and appropriate investigations if indicated.

The competent candidate should:

Preventive health measures:
- Cardiovascular risk screening: BP check, cholesterol, glucose if indicated.
- Cancer screening: Ensure Pap smear and mammogram are up to date.
- Weight and lifestyle discussion: Encourage exercise and a balanced diet.
Mental health assessment if anxiety about health is a concern.
Personalised approach to investigations:
- Blood tests only if indicated based on history and risk factors.
- No routine imaging unless red flags are present.
Patient education on health maintenance, including diet, exercise, and routine check-ups.
Arrange follow-up in 1-2 weeks for test results and further discussion.

SUMMARY OF A COMPETENT ANSWER

Takes a thorough history, identifying underlying concerns and risk factors.
Recognises the psychological impact of recent health scares.
Provides evidence-based recommendations, avoiding unnecessary tests.
Explains the role of screening and targeted investigations.
Uses shared decision-making, ensuring patient concerns are addressed.
Provides a structured follow-up plan, reinforcing continuity of care.

PITFALLS

Failing to explore underlying concerns, missing a hidden agenda (e.g., anxiety about cancer).
Over-ordering investigations, including unnecessary blood tests or imaging.
Dismissing the patient’s concerns without explanation or reassurance.
Not addressing preventive health measures, missing an opportunity for screening.
Neglecting to provide a follow-up plan, leading to uncertainty about next steps.

REFERENCES

MARKING

Each competency area is rated 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 Engages the patient to understand their concerns and expectations.
1.2 Demonstrates active listening and empathy.
1.4 Explains diagnosis and management in a patient-centred manner.

2. Clinical Information Gathering and Interpretation

2.1 Takes a comprehensive history, including psychosocial factors.
2.2 Identifies underlying concerns contributing to the reason for encounter.

3. Diagnosis, Decision-Making and Reasoning

3.1 Establishes a working diagnosis based on patient concerns and clinical reasoning.
3.2 Recognises when further clarification is required to ensure patient needs are addressed.

4. Clinical Management and Therapeutic Reasoning

4.1 Develops an evidence-based management plan.
4.7 Uses shared decision-making to address concerns.

5. Preventive and Population Health

5.1 Identifies and addresses preventive health opportunities.

Competency at Fellowship Level

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