CASE INFORMATION

Case ID: CCE-2025-EM01
Case Name: Sarah Thompson
Age: 42
Gender: Female
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: T99 (Endocrine/metabolic disorder NOS), A34 (Blood test)

COMPETENCY OUTCOMES

Competency Domain	Competency Element
1. Communication and Consultation Skills	1.1 Communicates appropriately to the sociocultural context. 1.2 Engages the patient to gather relevant information about symptoms, concerns, and expectations. 1.4 Communicates effectively in difficult situations.
2. Clinical Information Gathering and Interpretation	2.1 Conducts a structured history to assess endocrine/metabolic concerns. 2.2 Interprets blood test results accurately.
3. Diagnosis, Decision-Making and Reasoning	3.1 Synthesises clinical information to formulate a differential diagnosis.
4. Clinical Management and Therapeutic Reasoning	4.1 Develops a safe and patient-centred management plan.
5. Preventive and Population Health	5.1 Identifies risk factors and provides preventive health advice.
6. Professionalism	6.1 Demonstrates empathy and professionalism in discussing test results.
7. General Practice Systems and Regulatory Requirements	7.1 Ensures appropriate follow-up of test results.
9. Managing Uncertainty	9.1 Identifies and explains uncertainty in test results.
10. Identifying and Managing the Patient with Significant Illness	10.1 Recognises and manages a significant endocrine/metabolic disorder.

CASE FEATURES

Needs guidance on lifestyle changes, monitoring, and follow-up.
Patient presents to discuss recent blood tests ordered for fatigue, weight gain, and lethargy.
Blood test results show borderline hypothyroidism (TSH 5.5 mU/L, free T4 at lower limit of normal).
Past history includes gestational diabetes but no history of known endocrine disorders.
Concerned about weight gain and asks if she has a thyroid problem.
Anxious about whether medication is needed.
No obvious goitre or significant symptoms suggestive of severe hypothyroidism.

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

Sarah Thompson, a 42-year-old woman, presents for a follow-up consultation regarding recent blood tests ordered due to fatigue, mild weight gain, and low energy levels. She is concerned about whether she has a thyroid condition and asks whether she needs medication.

Her test results show TSH 5.5 mU/L (mildly elevated), with free T4 at the lower end of normal, suggesting subclinical hypothyroidism. She has a history of gestational diabetes, making her slightly higher risk for metabolic syndrome.

PATIENT RECORD SUMMARY

Patient Details

Name: Sarah Thompson
Age: 42
Gender: Female
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

No known drug allergies.

Medications

No regular medications.

Past History

Gestational diabetes (age 35) – resolved postpartum.
No previous thyroid disease.

Social History

Works in corporate administration, sedentary job.

Family History

Mother has type 2 diabetes.
No family history of thyroid disorders.

Smoking & Alcohol

Non-smoker.
Occasional alcohol, 1-2 drinks per week.

Vaccination & Preventive Activities

Mammogram: pending, scheduled in 6 months.
Up to date with vaccinations.
Last pap smear: 2 years ago (normal).

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

“Hi, doctor. I’m here for my blood test results. I’ve been feeling tired, and I wanted to check if my thyroid is the problem.”

General Information

You have been feeling tired and sluggish for the past few months. You wake up unrefreshed and feel low energy during the day.
You work in an office job and find it hard to stay alert in the afternoon. You rely on coffee but still feel tired.
You have gained about 5 kg in the last six months, despite trying to eat healthier and exercising more.
You don’t feel like yourself and are worried that something is wrong with your thyroid.

Specific Information

(Only reveal if asked appropriately)

Background Information

You have looked up hypothyroidism online and think the symptoms sound like what you’re experiencing.
You have always struggled with weight loss, but it seems harder than ever now.
You have gestational diabetes in your past and worry about developing diabetes later in life.
You have no known family history of thyroid disease, but your mother has type 2 diabetes.

Symptoms

You don’t feel cold all the time but prefer warmer weather.
Your periods are regular, occurring every 28–30 days, with normal flow.
You don’t have significant constipation but feel a little bloated at times.
Your skin is slightly dry, but you don’t have significant hair loss.
No hoarseness, difficulty swallowing, or neck pain.
You don’t have muscle weakness or joint pain, just occasional fatigue.
You have no headaches, vision changes, or mood swings.

Lifestyle & Diet

You eat fairly healthy, trying to avoid processed foods and cutting carbs recently.
You try to walk 30 minutes a day but find it hard to stay motivated when you’re always tired.
You drink 2-3 cups of coffee a day to keep going.
You don’t smoke and only drink alcohol occasionally (1-2 drinks per week).

Concerns & Expectations

You think this is a thyroid problem and are worried it will get worse.
You want to know if you need thyroid medication.
You don’t like taking unnecessary medication but don’t want to feel worse.
You wonder if medication will help with weight loss.
You want reassurance that this isn’t serious.
You fear developing diabetes and want to know if your weight gain puts you at risk.

Emotional Cues & Reactions

If the doctor is clear and explains well

You feel relieved if they explain what subclinical hypothyroidism means and whether treatment is necessary or not.
You accept that monitoring may be appropriate if explained well.
You feel encouraged if they provide practical lifestyle advice.

If the doctor is vague or dismissive

You feel frustrated if they just say “your levels are slightly off” without explaining what that means.
You push back: “So what does that mean for me? Do I need to do something about it?”
If they seem uncertain, you ask: “Should I see a specialist?”

If the doctor focuses only on lifestyle and ignores your concerns

You feel unheard and say, “I’ve already been trying to eat better and exercise. But it’s not working. What else can I do?”
You become more anxious and ask, “Could this get worse if I don’t take medication?”

If the doctor rushes to prescribe medication without discussion

You hesitate: “Are you sure I need medication right now? I don’t want to take something unless I really have to.”
You ask about alternative approaches: “Is there anything else I can try first?”

Questions for the Candidate

“So, do I have a thyroid problem?”
“Do I need to take medication?”
“Is this why I can’t lose weight?”
“Will this get worse over time?”
“Is there anything I should do to prevent it from getting worse?”
“Should I see a specialist?”

Key Takeaways for the Candidate

This is a mild, borderline case of hypothyroidism, not an urgent issue.
Monitoring and lifestyle changes may be the best initial approach.
The patient’s concerns must be acknowledged, even if medication isn’t immediately required.
Clear communication is essential—medical jargon will make the patient feel more confused.

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Explain the blood test results to the patient and address their concerns.

The competent candidate should:

Clearly explain the results in a way the patient understands, avoiding medical jargon.
Confirm the patient’s symptoms (fatigue, weight gain, sluggishness) and link them to the findings.
Clarify whether the thyroid function is normal, borderline, or indicative of hypothyroidism.
Discuss the management options:
- If results are normal, provide reassurance and explore other possible causes of symptoms.
- If borderline or subclinical hypothyroidism, discuss watchful waiting vs. treatment initiation based on guidelines and patient preference.
- If overt hypothyroidism, explain the need for thyroid hormone replacement therapy.
Acknowledge the patient’s concerns about weight gain and fatigue, offering holistic lifestyle advice.
Check the patient’s understanding and encourage questions.

Task 2: Outline the management plan, including lifestyle modifications and follow-up.

The competent candidate should:

Provide individualised advice based on the patient’s test results, symptoms, and risk factors.
If treatment is required, discuss thyroxine replacement therapy:
- Explain how to take the medication, possible side effects, and the need for regular monitoring.
If no immediate treatment is needed, provide reassurance and advise repeat blood tests in 3-6 months.
Discuss weight management strategies, emphasising:
- Balanced diet and portion control.
- Regular exercise that is realistic and sustainable for the patient.
- Minimising processed foods and excessive caffeine intake.
Address the patient’s concern about diabetes risk, discussing prevention strategies such as maintaining a healthy weight and regular screening.
Offer psychosocial support if the patient is feeling distressed about their health.

SUMMARY OF A COMPETENT ANSWER

Explains blood test results in clear, non-medical language.
Validates patient’s symptoms and concerns.
Outlines management options based on Australian guidelines.
Provides patient-centred lifestyle and weight management advice.
Offers reassurance and clear follow-up plan.

PITFALLS

Using medical jargon without checking the patient’s understanding.
Focusing only on the test results without addressing the patient’s symptoms and concerns.
Failing to explain the rationale for treatment or watchful waiting.
Not discussing lifestyle modifications as part of holistic management.
Neglecting to offer follow-up and monitoring advice.

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 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 Uses a structured approach to history-taking and clinical reasoning.

3. Diagnosis, Decision-Making and Reasoning

3.2 Applies relevant guidelines to clinical decision-making.

4. Clinical Management and Therapeutic Reasoning

4.1 Develops an individualised management plan based on clinical findings.

5. Preventive and Population Health

5.1 Incorporates lifestyle and preventive strategies into patient care.

6. Professionalism

6.3 Respects patient autonomy in shared decision-making.

7. General Practice Systems and Regulatory Requirements

7.2 Understands the need for appropriate follow-up and monitoring.

9. Managing Uncertainty

9.1 Explains when and why monitoring is required.

Competency at Fellowship Level

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