CASE INFORMATION

Case ID: CCE-2025-002
Case Name: Emma Dawson
Age: 32
Gender: Female
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: W78 (Antenatal care) / W79 (Postnatal care)

COMPETENCY OUTCOMES

Competency Domain	Competency Element
1. Communication and Consultation Skills	1.1 Communicates effectively in a patient-centred manner 1.2 Elicits symptoms, ideas, concerns, and expectations 1.4 Provides clear explanations and engages in shared decision-making
2. Clinical Information Gathering and Interpretation	2.1 Gathers relevant history for pre/postnatal care 2.3 Identifies risk factors impacting maternal and fetal health
3. Diagnosis, Decision-Making and Reasoning	3.1 Recognises normal and abnormal pregnancy/postpartum changes 3.3 Identifies urgent referral needs
4. Clinical Management and Therapeutic Reasoning	4.1 Provides appropriate pregnancy/postnatal care advice 4.2 Offers pharmacological and non-pharmacological interventions
5. Preventive and Population Health	5.1 Provides education on maternal and infant health, including breastfeeding 5.3 Screens for perinatal mental health conditions
6. Professionalism	6.1 Provides non-judgmental and culturally sensitive care
7. General Practice Systems and Regulatory Requirements	7.1 Adheres to Australian pregnancy care guidelines and documentation
9. Managing Uncertainty	9.1 Manages uncertainty related to pregnancy complications or postpartum concerns
10. Identifying and Managing the Patient with Significant Illness	10.1 Recognises red flags for postpartum complications (e.g., postpartum haemorrhage, infection, mental health risks)

CASE FEATURES

Risk assessment for pre-eclampsia, gestational diabetes, postpartum complications
Routine antenatal (28-week) or postnatal (6-week) check-up
Pregnancy history: previous miscarriage, GDM in last pregnancy
Concerns about fetal movements (if antenatal) or breastfeeding issues (if postnatal)
Screening for perinatal depression/anxiety
Patient unsure about vaccinations (e.g., whooping cough, influenza)

INSTRUCTIONS

You have 15 minutes to complete this consultation.

Treat this consultation as if it is face-to-face.

You are not required to perform a physical examination.

A patient record summary is provided for your reference.

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

Emma Dawson is a 32-year-old woman who presents for her routine antenatal (28-week) or postnatal (6-week) check-up.

She had gestational diabetes in her previous pregnancy, leading to an induced labour at 38 weeks. She also had one previous miscarriage at 10 weeks.

If antenatal, she is concerned about fetal movements, gestational diabetes screening, and vaccinations.

PATIENT RECORD SUMMARY

Patient Details

Name: Emma Dawson
Age: 32
Gender: Female
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

No known allergies

Medications

Pregnancy multivitamins
Iron supplements

Past History

Previous miscarriage (10 weeks, 2018)
Gestational diabetes (2021, diet-controlled)
Induced labour at 38 weeks (previous pregnancy)

Social History

Works part-time as a teacher
Non-smoker, drinks alcohol occasionally (stopped during pregnancy)

Family History

Mother had gestational diabetes and Type 2 diabetes
Father has hypertension and hyperlipidaemia

Vaccination and Preventative Activities

Cervical screening test up to date
Unsure about whooping cough, influenza, and COVID-19 vaccines

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 just came in for my pregnancy/postnatal check-up, but I do have a couple of questions.”

General Information

(Provide if the candidate asks open-ended questions like “How has your pregnancy/postnatal period been?”)

Antenatal (28-week check-up)

“Overall, I feel okay, but I have been a little worried about the baby’s movements. Some days it feels less active, and I’m not sure if that’s normal.”
“I had gestational diabetes in my last pregnancy, and I’m nervous about doing the glucose test again. What happens if I have it this time?”
“I’ve heard mixed things about the whooping cough vaccine. I had it in my last pregnancy—do I need it again?”
“My sleep has been terrible because I can’t get comfortable. Is that normal?”

Postnatal (6-week check-up)

“It’s been really tiring. The baby is feeding okay, but my nipples are sore, and I don’t know if the latch is right. How do I know if it’s normal?”
“I feel more emotional than usual. Some days I just cry, but I think it’s just because I’m tired. How do I know if it’s something more serious?”
“I haven’t thought much about contraception, but I don’t want to get pregnant too soon. What are my options?”
“I had gestational diabetes. Do I need another test to check if I still have it?”

Specific Information

(Provide only when the candidate asks direct, specific questions.)

Antenatal (28-week check-up)

Fetal movements:
- “Some days I notice lots of movement, but other days it seems less. When I lie down and really focus, I do feel kicks, but I don’t know if it’s enough.”
Gestational Diabetes:
- “Last time, my blood sugars were managed with diet, but I’m scared I might need insulin this time. Will that affect my birth options?”
Vaccinations:
- “I know whooping cough is recommended, but I had it in my last pregnancy. Does it really make a difference?”
- “I also haven’t had the flu shot yet. Is it really necessary?”
Sleep Issues:
- “I wake up multiple times a night. I can’t find a comfortable position, and I get heartburn, which makes it worse.”
- “I’ve heard about pregnancy pillows—do they actually help?”

Postnatal (6-week check-up)

Breastfeeding:
- “My baby feeds every two hours, which feels like all the time. I don’t know if it’s normal or if something’s wrong with my supply.”
- “My nipples hurt, especially at the start of a feed. Is that normal, or should I get help?”
Mood and Emotional Wellbeing:
- “Most days, I feel okay, but I get teary over small things, like if the baby won’t settle. I feel guilty for getting frustrated.”
- “I don’t feel like myself, but I don’t know if that’s just part of being a new mum.”
- (If asked about support) “My husband helps when he can, but he works full-time. My mum comes over sometimes, but she has her own things going on.”
Postnatal Check-up Concerns:
- “I had a few stitches after birth, and I still feel a bit sore. Is that normal?”
- “When should I expect my period to return?”
Contraception:
- “I don’t think I want another baby too soon, but I also don’t like the idea of taking the pill every day. What are my options?”

Emotional Cues & Body Language

Antenatal:
- Looks concerned when discussing fetal movements.
- Becomes anxious when discussing gestational diabetes.
- Seems uncertain about vaccines but is open to information.
Postnatal:
- Appears visibly tired and rubs her eyes.
- Gets teary when talking about feeling emotional or struggling with breastfeeding.
- Shows hesitation when discussing postnatal contraception, unsure what’s best.

Questions for the Candidate

(Ask these naturally during the consultation.)

“How do I know if my baby’s movements are normal?”
“What happens if I have gestational diabetes again?”
“Do I really need a flu shot while pregnant?”
“How can I tell if I have postnatal depression?”
“What contraception is best while breastfeeding?”
“If I have trouble breastfeeding, where can I get help?”
“What happens if my gestational diabetes doesn’t go away?”
“What should I look out for in case I have postpartum complications?”

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take an appropriate history from the patient regarding her antenatal/postnatal check-up.

The competent candidate should:

Use open-ended and targeted questions to assess the patient’s general well-being.
Explore obstetric history, including previous pregnancies, complications, and current pregnancy status (if antenatal).
Ask about fetal movements, symptoms of gestational diabetes, vaccinations, and sleep disturbances (antenatal) or mood, breastfeeding concerns, postnatal contraception, and recovery (postnatal).
Assess for risk factors such as previous gestational diabetes, mental health issues, and lack of support.
Use empathetic communication, actively listening to concerns while acknowledging her experiences.

Task 2: Explain the necessary investigations and their relevance.

The competent candidate should:

Discuss routine antenatal tests (e.g., glucose tolerance test, iron levels, and vaccinations) if antenatal.
Explain the importance of the 6-week postnatal check, including screening for postpartum depression, gestational diabetes follow-up, and pelvic floor assessment.
Address any misconceptions about vaccinations, blood tests, or contraception safety while breastfeeding.
Provide reassurance regarding normal postnatal symptoms versus concerning signs requiring further review.

Task 3: Provide appropriate management advice and address concerns.

The competent candidate should:

Give evidence-based recommendations on fetal movements, gestational diabetes, vaccinations, sleep strategies, and breastfeeding support.
Offer mental health screening using tools like the Edinburgh Postnatal Depression Scale (EPDS) if concerns arise.
Discuss contraceptive options, ensuring they align with patient preferences and breastfeeding status.
Provide practical strategies for sleep, emotional well-being, and postpartum recovery.
Offer follow-up appointments or referrals, such as to a lactation consultant, perinatal psychologist, or physiotherapist for pelvic floor issues.

SUMMARY OF A COMPETENT ANSWER

Comprehensive history-taking, covering antenatal or postnatal concerns, mental health, breastfeeding, and contraception.
Clear and patient-centred explanations of investigations, reassuring the patient while addressing potential risks.
Holistic management plan, incorporating physical, emotional, and social well-being.
Empathetic communication, actively listening to concerns and validating emotions.
Evidence-based advice tailored to pregnancy or postpartum concerns, ensuring safe and informed decision-making.

PITFALLS

Failure to screen for mental health concerns, particularly postnatal depression or anxiety.
Not addressing fetal movement concerns properly, missing potential warning signs.
Inadequate discussion of postnatal contraception, leaving the patient uninformed about her options.
Lack of patient-centred communication, using medical jargon without ensuring understanding.
Failure to provide follow-up or referrals, missing opportunities for ongoing care.

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, and impact of illness.
1.4 Communicates effectively in routine and difficult situations.

2. Clinical Information Gathering and Interpretation

2.1 Gathers and interprets relevant clinical information systematically.
2.2 Identifies risk factors affecting pregnancy/postnatal health.

3. Diagnosis, Decision-Making and Reasoning

3.1 Develops a patient-centred problem list.
3.2 Differentiates between normal physiological changes and concerning symptoms.

4. Clinical Management and Therapeutic Reasoning

4.1 Develops an evidence-based management plan.
4.2 Provides safe and appropriate postnatal contraception advice.

5. Preventive and Population Health

5.1 Identifies and provides relevant health education (e.g., vaccinations, mental health screening).

6. Professionalism

6.1 Demonstrates patient-centred care and shared decision-making.

7. General Practice Systems and Regulatory Requirements

7.1 Documents patient concerns and management appropriately.

9. Managing Uncertainty

9.1 Recognises red flags and when referral is needed (e.g., fetal movements, postpartum depression).

10. Identifying and Managing the Patient with Significant Illness

10.1 Recognises and manages complications (e.g., gestational diabetes, postnatal complications).

Competency at Fellowship Level

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