CASE INFORMATION

Case ID: CCE-2025-01
Case Name: Peter Johnson
Age: 55
Gender: Male
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: K30 – Cardiovascular preventive procedure

COMPETENCY OUTCOMES

Competency Domain	Competency Element
1. Communication and Consultation Skills	1.1 Engages the patient to understand their health beliefs and concerns 1.2 Uses appropriate strategies to motivate and assist in lifestyle changes 1.4 Checks for patient understanding of preventive health interventions
2. Clinical Information Gathering and Interpretation	2.1 Gathers and interprets relevant risk factor information for cardiovascular disease
3. Diagnosis, Decision-Making and Reasoning	3.3 Identifies risk levels using appropriate tools (e.g., AUSDRISK, QRISK3)
4. Clinical Management and Therapeutic Reasoning	4.4 Develops an individualised, evidence-based management plan for cardiovascular risk reduction
5. Preventive and Population Health	5.1 Provides evidence-based cardiovascular prevention strategies including lifestyle and pharmacological interventions
6. Professionalism	6.3 Maintains a patient-centred and culturally appropriate approach
7. General Practice Systems and Regulatory Requirements	7.2 Uses appropriate MBS-rebated health assessments and referrals
9. Managing Uncertainty	9.1 Manages uncertainty in cardiovascular risk estimation and shared decision-making
10. Identifying and Managing the Patient with Significant Illness	10.2 Identifies and appropriately escalates high-risk cardiovascular patients

CASE FEATURES

Middle-aged male presenting for a routine health check
Elevated cardiovascular risk factors (family history, lifestyle, borderline BP)
Exploring primary prevention strategies including lifestyle, medication, and screening
Discussing risk communication and shared decision-making

INSTRUCTIONS

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

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

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

Peter Johnson, a 55-year-old office manager, presents for his annual health check. He feels well but is concerned about his family history of heart disease. His father had a heart attack at 58, and his older brother, aged 60, is on blood pressure medication.

His recent blood test results include:

PATIENT RECORD SUMMARY

Patient Details

Name: Peter Johnson
Age: 55
Gender: Male
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

Nil known

Medications

Nil regular

Past History

Nil significant

Social History

Occupation: Office Manager

Family History

Father: Myocardial infarction at 58
Older brother: Hypertension on medication

Smoking

Never smoked

Alcohol

2–3 standard drinks per night

Vaccination and Preventative Activities

Influenza vaccine annually

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 SCRIPT

Opening Line

“I just came in for my annual check-up, but I guess I should also ask—do I need to worry about heart disease like my dad?”

General Information

(Freely shareable when asked general, open-ended questions)

You feel well overall and have no major health complaints.
You have no diagnosed medical conditions, but you have never had a full heart check-up before.
You work full-time as an office manager, sitting at a desk most of the day.
You are married, and your two adult children live independently.
You know you have gained some weight, especially around your belly, over the last few years.

Specific Information

(Only reveal when the candidate asks the right questions)

Background Information

Your diet is not great—you eat takeaway food for lunch most days and usually have dinner at home, but it often includes processed or packaged foods.
You are not a smoker and have never smoked.
You drink alcohol most nights, usually 2-3 standard drinks of beer or wine, sometimes more on weekends.
You rarely exercise, apart from walking occasionally.
You are not on any medications, but you have heard about statins and worry about side effects.

Lifestyle & Cardiovascular Risk Factors

You have been less active in the last few years, and you find it hard to fit in exercise with your work schedule.
Your weight has been creeping up, and you feel like your pants are tighter around the waist.
You get breathless more easily than before, but you assume it’s just because you are unfit.
You don’t actively avoid salt or sugar in your diet.
You don’t think your alcohol intake is excessive, but you wonder if it might be a problem.
You are not a fan of taking tablets unless absolutely necessary.

Family History & Perception of Risk

Your father had a heart attack at 58. It was unexpected, and he was fairly fit and active.
Your older brother (60 years old) is on blood pressure medication, but he has not had a heart attack.
You don’t feel like you’re at risk because you feel fine and don’t have any obvious health problems.
You think heart disease mainly affects older people or those with obvious symptoms.
You are open to tests and health advice, but you want to know if they are really necessary.

Concerns & Questions About Prevention

You have heard that statins cause muscle pain—your friend started them and had to stop because of side effects.
You are not keen on lifelong medication but would consider it if you really need it.
You wonder if lifestyle changes alone can reduce your risk enough to avoid medication.
You are curious about alternative tests like calcium scoring or heart scans—are they better than a cholesterol test?
You are worried that cutting alcohol or eating healthier might not be worth the effort.

Emotional Cues & Body Language

You start off relaxed, treating this as a routine check-up.
When discussing family history, you become slightly more serious and reflective.
You look skeptical when medications are mentioned, especially statins.
You become more engaged if the doctor explains things visually or with numbers (e.g., risk calculators).
If the doctor pressures you too much about lifestyle changes, you might push back with, “I’ve been fine so far, why should I change now?”

Questions for the Candidate

(Ask these at different points to guide the conversation)

“How bad is my risk, really?”
“If I change my diet and exercise, can I avoid medication?”
“Are there any tests I should do to check my heart?”
“I’ve heard statins cause muscle pain—is that true?”
“What do you think is the best way to prevent heart disease?”
“Would taking aspirin help prevent a heart attack?”
“What’s the difference between good and bad cholesterol? Should I worry about it?”

Potential Pushback Responses (if the doctor is too directive)

“But my dad was fit, and he still had a heart attack—so how much difference do lifestyle changes really make?”
“I’ve been eating this way for years, and I feel fine.”
“I don’t want to take tablets unless I have to. Isn’t there something more natural I can do?”
“Do I really need to worry about this now? I thought this was an issue for later in life.”

Ideal Candidate Approach

The best candidate will:

Engage you in shared decision-making, rather than just listing changes you “must” make.
Explain your risk in a clear, personalised way using risk calculators.
Provide realistic, practical advice on improving diet and exercise.
Address concerns about medication without dismissing your fears.
Offer a stepwise approach rather than overwhelming you with too many changes at once.

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take a targeted history focusing on cardiovascular risk factors.

The competent candidate should:

Use open-ended questions to explore the patient’s cardiovascular risk factors, including lifestyle, diet, exercise, smoking, alcohol intake, and family history.
Assess the patient’s perceptions of risk, identifying any misconceptions or concerns about heart disease and medication.
Gather details on weight trends, physical activity levels, and symptoms such as breathlessness or chest discomfort.
Clarify modifiable risk factors, such as dietary habits, alcohol consumption, and physical activity levels.
Ask about previous cardiovascular screening tests and past discussions with healthcare providers about cardiovascular risk.
Demonstrate active listening and provide non-judgmental responses to encourage openness.

Task 2: Explain the concept of cardiovascular risk to the patient using an appropriate risk assessment tool.

The competent candidate should:

Use an Australian CVD risk calculator (e.g., Absolute Cardiovascular Risk Calculator, QRISK3).
Explain that cardiovascular risk is a combination of multiple factors rather than a single cause.
Present the patient’s risk level in an understandable way (e.g., “Your risk of having a heart attack or stroke in the next 5 years is approximately X%.”).
Address the importance of primary prevention, including lifestyle changes and medical interventions.
Use visual aids or metaphors (e.g., “Think of your arteries like pipes—too much cholesterol and high blood pressure can clog them.”).
Emphasise the modifiable vs. non-modifiable risks, focusing on what the patient can change.
Encourage shared decision-making, ensuring the patient understands and is involved in the discussion.

Task 3: Discuss preventive strategies, including lifestyle modification, pharmacological options, and screening.

The competent candidate should:

Provide personalised advice on dietary changes, including reducing processed foods, saturated fats, and salt, and increasing fruits, vegetables, and whole grains.
Discuss exercise recommendations (e.g., “Aim for at least 150 minutes of moderate-intensity exercise per week.”).
Address alcohol reduction strategies while acknowledging the patient’s concerns.
Explain the role of medications (e.g., statins, antihypertensives) and when they may be indicated.
Address concerns about statins, including evidence-based risk of side effects vs. benefits.
Consider additional screening options, such as coronary artery calcium scoring, if the patient is hesitant about medication.
Ensure recommendations are realistic and achievable, focusing on incremental changes rather than overwhelming the patient.

Task 4: Address any concerns or misconceptions the patient may have about cardiovascular disease prevention.

The competent candidate should:

Acknowledge the patient’s concerns about statins, explaining that muscle pain is uncommon and manageable.
Clarify that lifestyle changes alone may not be sufficient if the cardiovascular risk is high.
Address the belief that feeling fine means no risk, using silent progression of atherosclerosis as an example.
Explain why aspirin is not routinely recommended for primary prevention in low-risk patients.
Correct any misconceptions about alcohol, including the outdated belief that red wine is protective.
Encourage follow-up and re-evaluation, reinforcing that cardiovascular prevention is an ongoing process.

SUMMARY OF A COMPETENT ANSWER

Engages the patient effectively, using open-ended questions and active listening.
Uses an evidence-based risk calculator to explain cardiovascular risk clearly.
Provides a structured, patient-centred discussion of preventive strategies.
Addresses misconceptions directly, using simple, relatable language.
Balances lifestyle and pharmacological options, respecting patient preferences.
Encourages shared decision-making, allowing the patient to actively participate in managing their risk.

PITFALLS

Failing to assess lifestyle factors in detail (e.g., not exploring alcohol intake, diet, or physical activity).
Overloading the patient with too much information, leading to confusion.
Not using a structured risk calculator, resulting in unclear or subjective risk assessment.
Dismissing patient concerns about statins, rather than providing balanced information.
Using medical jargon instead of plain language (e.g., “dyslipidaemia” instead of “high cholesterol”).
Being too prescriptive, rather than engaging in shared decision-making.
Failing to provide a follow-up plan, missing the opportunity for ongoing risk management.

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, expectations of healthcare and the full impact of their illness experience on their lives.
1.4 Communicates effectively in routine and difficult situations.

2. Clinical Information Gathering and Interpretation

2.1 Gathers and interprets relevant risk factor information for cardiovascular disease.

3. Diagnosis, Decision-Making and Reasoning

3.3 Identifies risk levels using appropriate tools (e.g., AUSDRISK, QRISK3).

4. Clinical Management and Therapeutic Reasoning

4.4 Develops an individualised, evidence-based management plan for cardiovascular risk reduction.

5. Preventive and Population Health

5.1 Provides evidence-based cardiovascular prevention strategies, including lifestyle and pharmacological interventions.

6. Professionalism

6.3 Maintains a patient-centred and culturally appropriate approach.

7. General Practice Systems and Regulatory Requirements

7.2 Uses appropriate MBS-rebated health assessments and referrals.

9. Managing Uncertainty

9.1 Manages uncertainty in cardiovascular risk estimation and shared decision-making.

10. Identifying and Managing the Patient with Significant Illness

10.2 Identifies and appropriately escalates high-risk cardiovascular patients.

Competency at Fellowship Level

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