CASE INFORMATION

Case ID: TR-002
Case Name: Michael O’Connor
Age: 34
Gender: Male
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: A80 (Trauma/Injury NOS)

COMPETENCY OUTCOMES

Competency Domain	Competency Element
1. Communication and Consultation Skills	1.1 Establishes rapport and engages patient in discussion 1.2 Elicits key details about the injury and patient concerns 1.3 Provides clear explanations regarding diagnosis and management
2. Clinical Information Gathering and Interpretation	2.1 Conducts a structured history to assess mechanism and severity of trauma 2.2 Identifies red flags that may indicate more serious injury
3. Diagnosis, Decision-Making and Reasoning	3.1 Forms an appropriate differential diagnosis based on history and presentation 3.2 Identifies when imaging or specialist referral is required
4. Clinical Management and Therapeutic Reasoning	4.1 Develops a safe and appropriate management plan 4.2 Provides advice on symptom relief, wound care, and rehabilitation
5. Preventive and Population Health	5.1 Discusses injury prevention strategies relevant to occupation or activity
6. Professionalism	6.1 Provides patient-centred care while ensuring medico-legal considerations are addressed
7. General Practice Systems and Regulatory Requirements	7.1 Provides appropriate documentation and referrals as required
8. Procedural Skills	8.1 Demonstrates knowledge of appropriate first-aid and immobilisation techniques
9. Managing Uncertainty	9.1 Balances conservative management with the need for further investigation
10. Identifying and Managing the Patient with Significant Illness	10.1 Recognises when escalation of care is necessary (e.g., fracture, compartment syndrome)

CASE FEATURES

Young male with acute injury following a fall
Potential for underlying fracture, soft tissue injury, or concussion
Concerns regarding return to work and long-term function
Need for assessment of red flags requiring escalation
Discussion on first-aid, pain management, and prevention strategies

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

Michael O’Connor, a 34-year-old warehouse worker, presents to your clinic after falling down a flight of stairs at work earlier today. He landed on his right side, with impact to his shoulder, elbow, and knee.

He reports persistent pain in his right shoulder and elbow and a mild headache since the incident. He was able to walk away from the scene, but now struggles with movement due to pain and stiffness. He denies loss of consciousness, but states he felt dazed for a few minutes after the fall.

PATIENT RECORD SUMMARY

Patient Details

Name: Michael O’Connor
Age: 34
Gender: Male
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

Nil known

Medications

Nil regular medications

Past History

Mild asthma as a child
No prior significant injuries

Social History

Works as a warehouse stock handler (lifting and carrying boxes daily)

Family History

Father: Hypertension
Mother: Type 2 diabetes

Smoking

Never smoked

Alcohol

Occasional drinking, 2-3 beers per week

Vaccination and Preventative Activities

Up to date with tetanus

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

“Doctor, I fell at work earlier today, and my right side is killing me. I need to know if it’s broken.”

General Information

(Freely given if the candidate asks open-ended questions like “Can you tell me more about that?”)

The fall happened around 11 AM today while walking down the metal staircase in the warehouse.
Slipped and landed heavily on the right side, particularly on the right shoulder, elbow, and knee.
Felt dazed for a few minutes but did not lose consciousness.
Pain has been getting worse throughout the day, especially in the right shoulder and elbow.

Specific Information

(Only given when the candidate asks direct questions)

Background Information

He has been able to move his arm and fingers, but it hurts a lot to lift the arm overhead.
His elbow feels stiff, and there is some swelling starting to appear around it.
Mild headache since the fall, but no vomiting, confusion, or vision changes.
Knee pain is less intense than the shoulder and elbow but feels stiff and slightly swollen.

Pain and Symptoms

Shoulder pain: Feels sharp when moving the arm, especially when reaching overhead. Resting makes it feel slightly better, but any movement worsens it.
Elbow pain: Aching and stiff, especially when bending the arm fully.
Knee pain: Feels dull and sore, but he can put weight on the leg and walk, although cautiously.
No numbness or tingling in the hand or fingers.
No major bruising yet, but the elbow and knee are feeling swollen.
Hasn’t taken any painkillers yet because he wasn’t sure if it would help or make things worse.

Occupational Concerns

Works as a warehouse stock handler—job involves lifting and carrying heavy boxes all day.
Worried about missing work—his boss expects him to be back tomorrow.
If he can’t lift things, he might not be able to work properly.
Scared that he might have a fracture, which could mean weeks off work.

Medical and Social History

No previous broken bones or serious injuries.
Never had a concussion before but knows people who have.
Lives alone, but his sister lives nearby if he needs help.
No history of blackouts, seizures, or dizziness in the past.

Concerns and Questions for the Doctor

“Do I need an X-ray? Could it be broken?”
“How long until I can use my arm again?”
“Do I need to go to the hospital?”
“Should I take painkillers, or just rest it?”
“Can I go back to work tomorrow, or do I need time off?”
“If I keep moving my arm, will I make it worse?”
“What if it doesn’t get better? Will I need surgery?”
“How do I know if I have a concussion? Do I need to worry about my head?”

Emotional Responses & Body Language

Anxious and frustrated, rubbing his shoulder occasionally while speaking.
Guards his right arm, trying to keep it still as much as possible.
Looks slightly tense, especially when talking about work and whether he can return tomorrow.
Sighs and shakes his head when discussing pain and swelling, showing discomfort.
Appears slightly worried when asking about fractures or needing an X-ray, as if expecting bad news.
Leaning forward when asking about work concerns—this is very important to him.
Scratches his head occasionally when talking about his mild headache, unsure if it’s serious.

Key Behaviours to Demonstrate Realism

If the doctor moves too quickly toward management, act confused and say:
- “Wait, but do I need an X-ray? How do you know if it’s broken or not?”
If the doctor mentions rest or time off work, respond frustratedly:
- “I really can’t afford to be off for too long. Is there any way I can still do something at work?”
If the doctor asks about pain relief, respond hesitantly:
- “I haven’t taken anything yet. I didn’t want to make it worse, you know?”
If the doctor seems uncertain, act nervous and push for answers:
- “So do you think it’s serious? Should I be worried?”

Final Patient Expectations

Wants clear advice on whether there is a serious injury.
Prefers not to go to the hospital unless absolutely necessary.
Needs guidance on whether he can return to work safely.
Wants pain relief options, but doesn’t want to rely on strong medications.
Interested in preventing future injuries at work, especially if this is something that could happen again.

Adjustments Based on Candidate Performance

If the candidate provides reassurance and clear explanations, the patient gradually becomes more relaxed.
If the candidate is uncertain or vague, the patient remains anxious and pushes for more answers.
If the candidate ignores work concerns, the patient keeps returning to the issue and expresses frustration.
If the candidate provides a rushed management plan, the patient insists on knowing if he needs an X-ray first.

Role-Player Notes for Examiners

Ensure the candidate takes a structured history, including mechanism of injury, functional impact, red flags, and medical history.
Look for appropriate clinical reasoning, ensuring the candidate rules out serious injuries.
The candidate should address patient concerns empathetically, particularly work-related anxieties.
They should provide clear advice on management, balancing pain relief, activity modification, and red flag monitoring.
If the candidate fails to ask about head injury symptoms, prompt the patient to mention feeling dazed after the fall to test concussion assessment skills.

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take a focused history regarding the mechanism of injury, symptoms, and concerns.

The competent candidate should:

Establish the exact mechanism of injury, including how the fall occurred, the direction of impact, and what parts of the body made contact.
Assess for red flags that may indicate serious injuries, such as:
- Head injury symptoms (loss of consciousness, vomiting, confusion).
- Neurological symptoms (weakness, numbness, paraesthesia).
- Signs of fractures or ligament damage (deformity, inability to bear weight, severe swelling).
Clarify symptom severity and progression since the injury.
Ask about functional limitations, including ability to move the affected limb and perform work duties.
Elicit patient concerns, particularly regarding work, imaging, and potential time off.
Review past medical history, including previous injuries, musculoskeletal issues, and comorbidities such as diabetes, which may impact healing.

Task 2: Explain your differential diagnosis to the patient, ensuring clarity and addressing concerns.

The competent candidate should:

Explain that the most likely diagnosis is a soft tissue injury involving the shoulder, elbow, and knee, given the mechanism of fall and reported symptoms.
Discuss potential differential diagnoses, including:
- Fractures (clavicle, humerus, radial head, patella) if there is significant pain, swelling, or deformity.
- Ligament or tendon injuries, such as rotator cuff strains or knee ligament sprains, if there is weakness or instability.
- Concussion if there are ongoing headaches or dizziness.
Address patient concerns about imaging, explaining that X-rays may be needed if there are fracture concerns, but mild soft tissue injuries often do not require imaging.
Reassure the patient that most minor musculoskeletal injuries improve with conservative management and early mobilisation is often beneficial.

Task 3: Develop a management plan, including conservative and escalation pathways.

The competent candidate should:

Advise on the RICE protocol (Rest, Ice, Compression, Elevation) in the first 48 hours.
Prescribe appropriate analgesia, such as paracetamol and NSAIDs (if no contraindications).
Advise on gradual mobilisation, avoiding activities that exacerbate pain.
Discuss occupational modifications, such as lighter duties or time off work if necessary.
Explain red flags requiring reassessment, such as worsening pain, increasing swelling, inability to move a limb, or neurological symptoms.
Consider referral for physiotherapy if functional impairment persists beyond the acute phase.
Schedule a review within 1 week to assess recovery and determine if further intervention is needed.

Task 4: Outline indications for imaging and referral, if necessary.

The competent candidate should:

Explain that imaging is required if there are red flags for fracture, such as:
- Bony tenderness, deformity, inability to bear weight or move a joint fully.
- High-risk mechanisms of injury (e.g., fall from height, direct high-impact trauma).
- Persistent pain despite initial conservative measures.
Refer for urgent imaging or specialist input if:
- A fracture or dislocation is suspected.
- Ligamentous instability is present, requiring orthopaedic assessment.
- Head injury symptoms worsen, indicating possible concussion complications.
If imaging is normal but pain persists, consider physiotherapy referral for rehabilitation.

SUMMARY OF A COMPETENT ANSWER

Takes a structured history, including the mechanism of injury, symptom progression, red flags, and functional impact.
Explains the likely diagnosis clearly, differentiating between soft tissue injury, fractures, and head trauma.
Develops a patient-centred management plan, prioritising pain relief, functional recovery, and work modifications.
Recognises when imaging or specialist referral is necessary, ensuring timely intervention for serious injuries.
Uses clear, empathetic communication, addressing patient concerns about work, pain, and prognosis.

PITFALLS

Failing to ask about the mechanism of injury, leading to missed red flags.
Overlooking potential head injury symptoms, such as dizziness or persistent headache.
Jumping to imaging unnecessarily, when clinical assessment suggests a minor soft tissue injury.
Not discussing work modifications, leaving the patient uncertain about returning to work safely.
Neglecting to provide safety-netting advice, such as when to return for reassessment if symptoms worsen.

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

Competency Domains Assessed

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, and expectations.
1.3 Provides clear explanations and reassurance regarding diagnosis and management.

2. Clinical Information Gathering and Interpretation

2.1 Conducts a structured history, including mechanism of injury and red flags.

3. Diagnosis, Decision-Making and Reasoning

3.1 Forms an appropriate differential diagnosis based on history and symptoms.

4. Clinical Management and Therapeutic Reasoning

4.1 Develops an evidence-based management plan, prioritising pain relief and functional recovery.

5. Preventive and Population Health

5.1 Provides advice on injury prevention and workplace safety.

6. Professionalism

6.1 Ensures medico-legal considerations are addressed, particularly regarding workplace injury.

7. General Practice Systems and Regulatory Requirements

7.1 Provides appropriate documentation and referrals as required.

8. Procedural Skills

8.1 Demonstrates understanding of first-aid principles and immobilisation techniques.

9. Managing Uncertainty

9.1 Balances conservative management with appropriate escalation when needed.

10. Identifying and Managing the Patient with Significant Illness

10.1 Identifies serious injuries requiring urgent referral.

Competency at Fellowship Level

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