CCE-CE-162 - GP Exams

CASE INFORMATION

Case ID: GP-GLA-001
Case Name: John Stevenson
Age: 65
Gender: Male
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: F93 (Glaucoma)

COMPETENCY OUTCOMES

Competency Domain	Competency Element
1. Communication and Consultation Skills	1.1 Communicates appropriately in a patient-centred manner. 1.2 Elicits the patient’s symptoms, concerns, and expectations. 1.4 Explains diagnosis and management in an understandable way.
2. Clinical Information Gathering and Interpretation	2.1 Takes a thorough history, including risk factors and symptoms of glaucoma. 2.2 Performs and interprets appropriate eye assessments.
3. Diagnosis, Decision-Making and Reasoning	3.1 Forms a differential diagnosis of glaucoma and other causes of visual disturbance.
4. Clinical Management and Therapeutic Reasoning	4.1 Develops an appropriate treatment plan based on evidence-based guidelines. 4.2 Recognises the need for ophthalmology referral and ongoing monitoring.
5. Preventive and Population Health	5.1 Identifies and advises on modifiable risk factors (e.g., smoking, lifestyle changes).
6. Professionalism	6.1 Communicates empathetically about chronic disease management.
7. General Practice Systems and Regulatory Requirements	7.1 Recognises the need for referral to an ophthalmologist and Medicare compliance for ongoing monitoring.
9. Managing Uncertainty	9.1 Recognises the need for further assessment and follow-up for vision loss.
10. Identifying and Managing the Patient with Significant Illness	10.1 Identifies vision-threatening conditions requiring urgent referral.

CASE FEATURES

Does not attend regular eye checks; lacks understanding of disease monitoring.
Elderly male with a recent diagnosis of glaucoma.
Mild vision changes but unaware of potential disease progression.
Concerned about blindness and impact on daily activities.
On prescribed eye drops but unsure about their necessity.

INSTRUCTIONS

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

This is a face-to-face consultation in a general practice setting.

You are not required to perform an examination but should base your management on provided findings.

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

John Stevenson, a 65-year-old retired builder, presents to your clinic for a routine medication review. He was diagnosed with primary open-angle glaucoma six months ago by an ophthalmologist. He was prescribed latanoprost eye drops but is inconsistent with their use, as he is not convinced he needs them since he does not notice major vision issues.

John is concerned about whether glaucoma will make him go blind and whether he really needs lifelong treatment. He also asks about alternative treatment options, such as surgery or laser therapy.

PATIENT RECORD SUMMARY

Patient Details

Name: John Stevenson
Age: 65
Gender: Male
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

Nil known

Medications

Latanoprost (Xalatan) 0.005% eye drops, one drop daily at night

Past History

Diagnosed with primary open-angle glaucoma six months ago
No history of diabetes, hypertension, or cardiovascular disease

Social History

Retired builder, lives with wife

Family History

Father had glaucoma and was blind in old age

Smoking

Occasionally smokes (2–3 cigarettes per week)

Alcohol

Drinks socially (1–2 beers on weekends)

Vaccination and Preventative Activities

Up to date with vaccinations

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.

SCRIPT FOR ROLE-PLAYER

Opening Line

“Doctor, I don’t really understand why I have to keep taking these eye drops. My vision is fine. Do I really need them?”

General Information

You are John Stevenson, a 65-year-old retired builder. You live with your wife and generally enjoy an independent lifestyle.

Six months ago, you went for a routine eye check-up because your wife insisted. The optometrist noticed increased eye pressure and referred you to an ophthalmologist, who diagnosed you with primary open-angle glaucoma.

Specific Information

(Only reveal if asked)

Background Information

The ophthalmologist prescribed latanoprost (Xalatan) eye drops and told you to use them every night. However, you don’t fully understand the need for this treatment, especially since you don’t feel any different.

Your father went blind in his late 70s from glaucoma, which worries you, but you’re not sure if the same thing will happen to you.

Symptoms & Vision History

You have mild blurriness in the mornings, but it goes away after a few hours.
No eye pain, redness, or itching.
No halos around lights or flashing lights.
You sometimes struggle with reading fine print, but you think this is just normal ageing.
You’ve never had headaches related to your vision.
Your night vision is not great, but you can still drive comfortably.

Treatment & Concerns

You are inconsistent with using the drops, sometimes skipping them because:
- You don’t feel any different when you take them.
- They sting a little, which makes you reluctant to use them.
- You occasionally forget to take them.
You don’t know how glaucoma actually affects your eyes and are not sure if it’s a big deal.
You’ve heard about laser treatment and surgery and wonder if those could be better than lifelong eye drops.
You want to know how soon you might go blind if you don’t use the drops regularly.
You don’t want regular specialist check-ups if you don’t feel symptoms.

Family History & Lifestyle

Your father went blind in his late 70s due to glaucoma.
No history of diabetes, hypertension, or cardiovascular disease.
You occasionally smoke (2–3 cigarettes per week) but have never been told smoking affects glaucoma.
You socially drink (1–2 beers on weekends).
You do not exercise regularly but are fairly active at home and in the garden.
You have no previous history of vision issues.

Emotional Responses & Body Language

You appear somewhat skeptical about the need for treatment.
You shrug and wave your hand dismissively when discussing the eye drops.
Your expression changes to concern when talking about your father’s blindness.
If the doctor explains the risks clearly, you nod slowly and listen carefully.
You become more engaged if the doctor reassures you and provides clear explanations.

Patient’s Concerns & Questions

“Do I really need these drops forever?”
- You feel like your vision is fine, so why take medication daily?
- You wonder if skipping them sometimes is okay.
“What happens if I just stop using them?”
- You want to know how fast glaucoma can make you go blind.
- You are skeptical about worsening symptoms, as you haven’t noticed much change.
“Can I just get laser surgery instead?”
- You’ve heard that laser treatment exists and wonder if it could replace eye drops.
- You are interested in alternatives but don’t know how effective they are.
“Will I go blind like my father?”
- You are genuinely worried but don’t fully understand your risk.
“Is there anything else I can do to protect my eyes?”
- You want to know if diet, exercise, or lifestyle changes could help.
- You’re not aware that smoking can worsen glaucoma.

How to Respond Based on the Doctor’s Approach

If the doctor explains glaucoma clearly and reassures you, you become more receptive.
If the doctor tells you to “just follow the treatment,” you remain skeptical.
If the doctor listens to your concerns and provides realistic options, you feel more in control.

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Explain to the patient why ongoing treatment for glaucoma is essential, even if they have no symptoms.

The competent candidate should:

Explain that glaucoma is a progressive disease that can lead to permanent vision loss if left untreated.
Clarify that early stages of glaucoma are asymptomatic, and damage occurs slowly over time without noticeable changes in vision.
Use simple language to describe how high eye pressure damages the optic nerve, leading to gradual peripheral vision loss and, eventually, blindness.
Emphasise that treatment with eye drops (e.g., latanoprost) helps reduce eye pressure, slowing down or preventing further damage.
Address the patient’s concerns about their father’s history of glaucoma-related blindness, reassuring them that early treatment significantly reduces this risk.
Reinforce the importance of regular specialist follow-ups to monitor disease progression and adjust treatment if needed.

Task 2: Address the patient’s concerns about alternative treatments, including laser surgery.

The competent candidate should:

Acknowledge the patient’s interest in laser surgery and explain that laser trabeculoplasty can be an option for some patients but does not always replace the need for eye drops.
Clarify that laser treatment improves drainage of fluid but may not work for everyone and can wear off over time, requiring additional treatment.
Mention that surgical options exist for advanced cases, but they are generally reserved for when medication and laser treatment fail.
Discuss the risks and benefits of each approach, ensuring the patient understands why first-line treatment is still the eye drops.

Task 3: Encourage adherence to medication and provide practical strategies to improve compliance.

The competent candidate should:

Acknowledge the patient’s frustration with the drops and validate their concerns about stinging and forgetfulness.
Offer practical strategies to improve adherence, such as:
- Setting a daily reminder (alarm, phone app).
- Keeping the drops next to their toothbrush as a visual cue.
- Using lubricating eye drops before or after latanoprost to reduce irritation.
- Demonstrating the correct way to administer eye drops to minimise discomfort.
Explain the consequences of irregular use, emphasising that skipping doses can lead to increased eye pressure and nerve damage.

SUMMARY OF A COMPETENT ANSWER

Explains glaucoma as a progressive disease with irreversible vision loss.
Addresses the patient’s concerns empathetically and provides clear explanations.
Discusses alternative treatments (laser, surgery), setting realistic expectations.
Reinforces medication adherence with practical solutions.
Encourages regular follow-ups for monitoring and treatment adjustments.

PITFALLS

Failing to explain that early glaucoma is asymptomatic, leading to poor adherence.
Not addressing patient concerns about their father’s blindness, missing an opportunity for reassurance.
Overpromising laser surgery as a cure, rather than explaining its limitations.
Ignoring side effects of eye drops, which may discourage compliance.
Neglecting to provide practical strategies to help with adherence.

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 information to confirm or exclude conditions.

3. Diagnosis, Decision-Making and Reasoning

3.2 Prioritises problems, diagnoses conditions, and justifies decisions.

4. Clinical Management and Therapeutic Reasoning

4.1 Develops management plans that align with current guidelines.

5. Preventive and Population Health

5.2 Identifies risk factors and provides appropriate preventive interventions.

6. Professionalism

6.3 Acts as an advocate for the patient’s well-being.

7. General Practice Systems and Regulatory Requirements

7.1 Understands referral pathways and shared-care arrangements.

9. Managing Uncertainty

9.2 Communicates uncertainty effectively while ensuring patient safety.

10. Identifying and Managing the Patient with Significant Illness

10.1 Recognises conditions requiring urgent intervention.

Competency at Fellowship Level

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