CASE INFORMATION

Case ID: CCE-CHOL-001
Case Name: Sarah Thompson
Age: 42
Gender: Female
Indigenous Status: Non-Indigenous
Year: 2024
ICPC-2 Codes: D98 (Cholecystitis/Cholelithiasis)

COMPETENCY OUTCOMES

Competency Domain	Competency Element
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. 2.2 Orders and interprets appropriate investigations.
3. Diagnosis, Decision-Making and Reasoning	3.1 Identifies key clinical features to guide diagnosis. 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. 4.2 Provides appropriate pharmacological and non-pharmacological management.
5. Preventive and Population Health	5.2 Provides appropriate lifestyle advice to prevent recurrence.
6. Professionalism	6.3 Acts as an advocate for patient 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.

CASE FEATURES

Works full-time as a schoolteacher and wants to understand treatment options.
42-year-old female presenting with episodic right upper quadrant pain lasting 30–60 minutes after fatty meals.
Associated nausea, bloating, and occasional vomiting.
Past history of mild intermittent reflux, no prior biliary issues.
No fever, jaundice, or recent weight loss.
Concerned about worsening frequency and severity of attacks.

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.

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 schoolteacher, presents with a 3-month history of episodic right upper quadrant (RUQ) pain that typically occurs after fatty meals. The pain lasts 30–60 minutes, is colicky in nature, and is sometimes associated with nausea and bloating. She reports no fever, jaundice, or unintended weight loss.

She is concerned about the increasing severity and frequency of her attacks and is worried about potential surgery. She seeks clarification on diagnosis and management options.

PATIENT RECORD SUMMARY

Patient Details

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

Allergies and Adverse Reactions

Nil known

Medications

Occasional antacids for reflux

Past History

Mild gastroesophageal reflux disease (GERD)
No prior gallbladder issues

Social History

Works as a schoolteacher

Family History

Mother had gallstones requiring cholecystectomy in her 50s.
No family history of bowel or pancreatic cancer.

Smoking

Never smoked

Alcohol

Rarely drinks alcohol

Vaccination and Preventative Activities

Recent normal Pap smear and mammogram
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.

ROLE-PLAYER SCRIPT

Opening Line:

“Hi Doctor, I’ve been having this annoying stomach pain on and off after eating, and I think it might be gallstones. I’m really worried about needing surgery—can you help me?”

General Information

(Freely Given if Asked Open-Ended Questions)

Pain started about three months ago and has been happening more often recently.
Typically occurs after meals, especially after eating greasy or fried food.
Pain lasts 30–60 minutes and then goes away on its own.
It’s a deep ache in the upper right side of the stomach.

Specific Information

(Only Provided if Asked Directly)

Background Information

Nausea and bloating sometimes happen with the pain.
No fever, chills, or yellowing of the skin.
No change in bowel habits—no diarrhoea or constipation.

Pain Characteristics

The pain feels crampy and comes in waves rather than being sharp or stabbing.
It’s not related to movement or position changes.
Feels worse after eating fatty foods.
Sometimes radiates to the right shoulder.

Concerns About Surgery

Worried about needing surgery because she has never had an operation before.
Feels anxious about being put under anaesthesia.
Wonders if there are medications that can dissolve gallstones.
Wants to avoid surgery if possible.

Diet and Lifestyle

Has started avoiding fatty foods but finds it frustrating.
Feels annoyed that she can’t enjoy food with her family anymore.
Wants to know if eating “healthier” will make the gallstones go away.

Impact on Daily Life

Pain makes her feel sick and low in energy after meals.
Avoids eating out with family or friends because she’s afraid of triggering pain.
Finds work difficult because the pain sometimes starts at school and she can’t focus.
Worried it might turn into something serious.

Emotional Responses and Body Language

Initially tense and anxious—crosses arms, furrows brows.
Relaxes slightly when reassured but remains sceptical about surgery.
Frowns or looks frustrated when discussing dietary restrictions.
Appears concerned when talking about long-term health risks.
Leans forward and nods when the doctor explains things clearly.

Questions for the Candidate

“Do I have to stop eating everything I enjoy?”
“Can I get rid of this without surgery?”
“What happens if I ignore it?”
“Is there a way to prevent it from getting worse?”
“If I do need surgery, what’s the recovery like?”

Key Role-Playing Notes for Examiners:

Challenge the candidate’s ability to explain the diagnosis clearly without causing excessive anxiety.
Test their skills in addressing fears and misconceptions about surgery.
Ensure they provide clear and practical dietary advice.
Assess their ability to provide reassurance and patient-centred management.

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take an appropriate history from the patient, including symptom characteristics, dietary triggers, and impact on daily life.

The competent candidate should:

Establish the onset, duration, and frequency of abdominal pain.
Identify pain characteristics (e.g., location, radiation, severity, and relation to meals).
Ask about associated symptoms (nausea, vomiting, bloating, fever, jaundice).
Explore dietary and lifestyle factors (fatty food intake, alcohol consumption).
Assess previous episodes and response to pain relief measures.
Identify any family history of gallstones or biliary disease.
Understand the patient’s concerns regarding surgery and explore their knowledge and expectations.
Explore the impact of symptoms on daily activities, work, and quality of life.

Task 2: Explain the likely diagnosis to the patient in a clear and reassuring manner.

The competent candidate should:

Use simple, non-medical language to explain likely biliary colic due to gallstones.
Clarify that symptoms are triggered by fatty food intake due to gallbladder contractions.
Explain the difference between biliary colic and acute cholecystitis.
Discuss the risk of complications (cholecystitis, cholangitis, pancreatitis).
Address patient concerns about surgery, explaining when it is required.

Task 3: Discuss the management plan, including lifestyle modifications, medical treatment, and potential need for surgical intervention.

The competent candidate should:

Advise dietary changes (reducing fatty foods, eating smaller meals).
Explain symptomatic relief (simple analgesia, antispasmodics).
Discuss when urgent care is needed (severe pain, fever, jaundice).
Outline indications for referral to a surgeon for elective laparoscopic cholecystectomy.
Provide reassurance and support regarding surgery if needed.

SUMMARY OF A COMPETENT ANSWER

Comprehensive history-taking covering symptom characteristics and impact.
Clear and empathetic communication when explaining the diagnosis.
Patient-centred management plan, addressing lifestyle changes and potential need for surgery.
Reassurance and education about the condition and treatment options.

PITFALLS

Failing to ask about dietary triggers and previous episodes.
Overcomplicating the explanation with excessive medical jargon.
Not addressing the patient’s concerns about surgery and alternative treatments.
Missing red flag symptoms that require urgent intervention.
Providing incorrect or outdated management advice (e.g., suggesting gallstones can be dissolved with diet alone).

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 relevant information through history-taking and interprets findings appropriately.

3. Diagnosis, Decision-Making and Reasoning

3.2 Forms a rational working diagnosis based on history and clinical reasoning.

4. Clinical Management and Therapeutic Reasoning

4.3 Proposes an evidence-based management plan appropriate to the condition and patient’s preferences.

5. Preventive and Population Health

5.1 Provides advice on risk factor modification and lifestyle changes.

6. Professionalism

6.3 Demonstrates a respectful and patient-centred approach.

9. Managing Uncertainty

9.1 Recognises when referral or further investigations are necessary.

10. Identifying and Managing the Patient with Significant Illness

10.2 Recognises potential complications and provides appropriate guidance.

Competency at Fellowship Level

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